Showing papers in "American Journal of Drug and Alcohol Abuse in 1996"
TL;DR: Dropouts were more likely to be African-American or Hispanic-American, younger, with an earlier onset of substance abuse, and among minorities, those with more education were less likely to drop out.
Abstract: The dropout rates among cocaine abusers in outpatient treatment programs have averaged 55%. We sought to find patient predictor variables associated with early attrition. Dropouts were more likely to be African-American or Hispanic-American, younger, with an earlier onset of substance abuse. Among minorities, those with more education were less likely to drop out. Patients who were less educated and smoked or injected cocaine were particularly prone to discontinue treatment prematurely. The implications of these findings, and promising interventions for reducing the dropout problem, are discussed.
133 citations
TL;DR: The research demonstrates that opiate addiction in this sample is most often associated with other comorbid psychopathology, and suggests a need for thorough assessment for general psychopathology in opioid addicts entering addiction treatment, especially assessment for anxiety and affective disorders.
Abstract: This study examines prevalence rates for DSM-III-R anxiety and affective disorders in three follow-up samples of opioid addicts who were treated with methadone maintenance. At least one anxiety disorder was diagnosed in 55% of the total sample. Affective disorders were found in 58%. At least one anxiety disorder coexisted with at least one affective disorder in 36% of the sample. The research demonstrates that opiate addiction in this sample is most often associated with other comorbid psychopathology. It suggests a need for thorough assessment for general psychopathology in opioid addicts entering addiction treatment, especially assessment for anxiety and affective disorders. It also suggests the need for treatment that focuses on diagnosed mental disorders in addition to drug counseling for the substance abuse disorder.
92 citations
TL;DR: Gender and racial differences in assault characteristics CR-PTSD prevalence rates were observed and women were more likely than men to perceive their life as endangered during a rape and men were younger than women when they experienced their first (or only) aggravated assault.
Abstract: There is a paucity of studies concerning the prevalence of crime-related posttraumatic stress disorder (CR-PTSD) in individuals with substance use disorders, despite documentation of particularly high prevalence rates of sexual and physical assault in this population. A central objective of the present investigation was to assess victimization experiences and CR-PTSD among individuals receiving inpatient treatment for substance use disorders and evaluate gender and racial differences in assault characteristics CR-PTSD prevalence rates. A total of 95 inpatients (34 men and 61 women; 41 African-Americans, 52 Caucasians, and 2 other minorities) were administered a structured interview to assess substance abuse/dependence, trauma, and PTSD. Approximately 90% of the participants had a lifetime history of sexual and/or physical assault, and approximately 50% had CR-PTSD. With the exception of rape, no gender differences in assault or CR-PTSD prevalence rates were observed. Women were more likely than men to perceive their life as endangered during a rape. Men were younger than women when they experienced their first (or only) aggravated assault and were more likely to have been assaulted by a family member. No racial differences were detected for assault or PTSD, although African-American patients were significantly more likely to identify cocaine as their primary drug than Caucasian patients. Given the strikingly high rate of comorbid CR-PTSD among substance use disordered patients, exploration of the type and timing of interventions would be of clinical interest.
89 citations
81 citations
TL;DR: It was found that women who used cocaine were much more likely to have used some combination of cigarettes, alcohol, and marijuana in addition to cocaine during pregnancy than soft drug users or abstainers.
Abstract: This study examined the drug use patterns of pregnant women in two inner city sites, selected to overrepresent cocaine users. Women who used cocaine were much more likely to have used some combination of cigarettes, alcohol, and marijuana in addition to cocaine during pregnancy. There was little difference in the patterns of drug use in the two study sites, Trenton, New Jersey, and northwestern Philadelphia. A number of demographic and lifestyle variables of cocaine users, soft drug users (cigarettes, alcohol, and/or marijuana), and abstainers were compared. The cocaine-using group was significantly older and had more children, had less stable and more isolated living situations, was less likely to be employed and more likely to be receiving public assistance during pregnancy, and was more likely to have a higher drug- and alcohol-using social environment and family history than soft drug users or abstainers. Of significance was that many of the high-risk lifestyle factors exhibited by cocaine users were also seen, albeit to a lesser extent, among the soft drug users. These findings have implications for the timing of intervention strategies that would be most effective.
77 citations
TL;DR: In this article, the relationship between the need for psychiatric consultation, illicit drug use, and zidovudine adherence in HIV-infected injection drug users (IDUs) in methadone maintenance treatment (MMT) was described.
Abstract: This study describes the relationship between the need for psychiatric consultation, illicit drug use, and zidovudine (AZT) adherence in HIV-infected injection drug users (IDUs) in methadone maintenance treatment (MMT). The treatment records of 57 IDUs in MMT who had been prescribed AZT between May and August of 1991 were reviewed. Those who required psychiatric consultation (P+, N = 46, 81%) were compared with those who did not require psychiatric consultation (P-, N = 11, 19%) on adherence to AZT treatment (using the mean corpuscular volume [MCV] as a biological marker), on recent illicit drug use, and on CD4 lymphocyte (T cell) count changes from the beginning to the end of AZT treatment. The P+ subjects were less likely than P- subjects to adhere to AZT treatment: fewer in the P+ group had an MCV outside of the normal range, and P+ subjects had a lower average monthly increase in MCV since the beginning of AZT treatment. Recent illicit drug use and CD4 lymphocyte count changes from the beginning to the end of AZT treatment did not show group differences. Psychiatric morbidity among HIV-infected IDUs in MMT is common, and may contribute to poor adherence to AZT treatment. Psychiatric screening and adherence-enhancing interventions should be targeted to IDUs entering drug treatment programs.
76 citations
TL;DR: It is concluded that case management, including providing transportation, contributes significantly to retention in substance abuse treatment during pregnancy.
Abstract: Participation in substance abuse treatment during pregnancy is associated with improved pregnancy outcomes. Case management has been proposed as one way to reduce barriers to receiving and continuing treatment. An evaluation was conducted on a case management program to retain pregnant women in drug treatment. Two hundred twenty-five pregnant women received case management services consisting of home visits, telephone counseling, transportation, and referral. All women contacted a substance abuse treatment center and most (56%) obtained treatment during pregnancy. Sociodemographic factors, personal and family history of substance use and drug treatment, protective services involvement, history of physical and sexual abuse, and need for tangible resources were assessed. Charts were reviewed at the substance abuse treatment center for number of visits and urine toxicology reports, and at the hospital for pregnancy outcome. Data were analyzed by LISREL path analysis. Five factors had significant path correlations to prenatal attendance at the substance abuse treatment center: history of protective services involvement, number of drugs ever used, currently receiving methadone, intensity of case management, and receiving transportation to drug treatment appointments. We conclude that case management, including providing transportation, contributes significantly to retention in substance abuse treatment during pregnancy.
74 citations
TL;DR: It is found that the medical students responsible for treating substance abuse are significantly less religiously and spirituality oriented than the patients they treat, and that the students do not indicate that spirituality is an important component in the care of these patients.
Abstract: This study compares the views on spirituality of dually diagnosed patients (diagnosed with both substance abuse and general psychiatric disorders) and medical students in order to investigate their respective orientations toward spirituality and their views of the importance of spirituality in the treatment of addiction. We administered a modified version of Feagin's “Orientation to Life and God Scale” to assess religious and spiritual orientation in both the patients and students. A second series of items was developed and administered in order to compare the patients' and students perceptions of the relative importance of a religious and spiritual orientation in substance abuse treatment. A third series of items was also given to compare the nature of religious and health-related services on the inpatient unit that patients and students most wanted to see improved. We found that the medical students responsible for treating substance abuse are significantly less religiously and spiritually oriented than...
69 citations
TL;DR: Examination of the relationship between psychological trauma and crack abuse among 158 women with a recent history of drug use who were incarcerated in a New York City jail facility found women who had lost custody of their youngest child were more likely to be regular crack uses.
Abstract: This investigation examines the relationship between psychological trauma and crack abuse among 158 women with a recent history of drug use who were incarcerated in a New York City jail facility. Interviewers obtained data on demographics, drug use, psychological trauma history, criminal history, social support, and coping behavior variables. Three-fourths of the total sample had used crack three or more times a week for a month in the past; a quarter had used other drugs, predominantly heroin, three or more times a week for a month in the past. Multiple logistic regression analysis was used to assess the association between adult psychological trauma variables (loss of custody of youngest child and lived in streets prior to arrest) and regular crack use in three sequential models. After adjusting for social support, coping behavior, demographics, and criminal history variables, women who had lost custody of their youngest child were 3.3 times more likely to be regular crack uses. Women who demonstrated more negative coping behavior and perceived themselves as having less emotional support were also more likely to be regular crack users. The association between childhood traumas (i.e., childhood sexual abuse, childhood physical abuse, parental alcohol abuse) and regular crack use was also assessed using multiple logistic regression; however, no significant associations were found between these childhood psychological traumas and regular crack use in both the unadjusted and adjusted models. Study findings underscore the importance of assessing environmental, interpersonal, and intrapersonal factors in tailoring treatment strategies for users of crack and other drugs.
68 citations
TL;DR: Although the Johnson Intervention was the most effective, the variations did show some measure of success and can be viewed as part of an Intervention continuum.
Abstract: The Johnson Intervention is a therapeutic technique in which members of the person's social network confront him or her about the damage the drinking or drug use has caused and the action they will take if treatment is refused. It is highly effective in engaging and retaining clients in inpatient treatment, but, since initial evaluations, two trends have emerged in the field. First, there has been an increase in the use of outpatient treatment and, second, a number of variations of the Johnson Intervention have been developed. The purpose of this study was to compare the effectiveness of the Johnson Intervention with four other methods of referral to outpatient treatment. The other methods included two naturally occurring types of referral (coerced and non-coerced) and two less intense and less costly variations of the Intervention (Unrehearsed and Unsupervised). Effectiveness was determined by both entry into and completion of treatment. A retrospective study was conducted on a sample of 331 cases drawn from an alcohol and other drug treatment agency. Those who had undergone the Johnson Intervention were more likely to enter treatment than those in any of the four other groups. Of those that entered treatment, the Johnson Intervention and the coerced referral groups were equally likely to complete treatment, and both groups were more likely to complete treatment than those in the other three types of referral. Although the Johnson Intervention was the most effective, the variations did show some measure of success and can be viewed as part of an Intervention continuum.
66 citations
TL;DR: In general, pretreatment client characteristics were not helpful in predicting length of time in treatment regardless of program type and few pretreatment characteristics were related to retention within programs and significant predictors differed across treatment settings.
Abstract: The purpose of this research was (a) to assess differences in retention patterns and discharge status across three program settings; and (b) to examine selected pretreatment characteristics that might help predict treatment retention, which was operationalized as length of time in treatment. Three groups of pretreatment characteristics were examined. They included demographic factors, drug use and treatment history, and psychological status and symptomology. Clients in the intensive day treatment program tended to stay longer and were more likely to successfully complete the program than either clients in the outpatient or the traditional residential programs. In general, pretreatment client characteristics were not helpful in predicting length of time in treatment regardless of program type. Few pretreatment characteristics were related to retention within programs and significant predictors differed across treatment settings.
TL;DR: An overview of SOS is provided and the results of a survey of SOS participants are described, to provide a preliminary picture of SOS members and to stimulate further research on this organization and its effectiveness.
Abstract: Self-help groups have assisted many in their recovery from alcohol use disorders. Although Alcoholics Anonymous (AA) is the largest self-help organization for addressing alcohol problems, no single organization can be suited to the needs of all alcohol abusers. For example, some alcoholics have chosen not to affiliate with AA because of objections to religious or spiritual references in the 12 steps of AA. It was largely for this reason that a secular self-help organization–Secular Organizations for Sobriety (SOS)–was established. This article provides an overview of SOS. Also described are the results of a survey of SOS participants. These data provide a preliminary picture of SOS members and will, we hope, stimulate further research on this organization and its effectiveness.
TL;DR: It is suggested that primary-care-based opioid maintenance using buprenorphine shows promise as a new approach to the treatment of heroin dependence.
Abstract: The treatment of heroin dependence with opioid maintenance has traditionally employed methadone and more recently buprenorphine administered in traditional drug treatment settings. In this pilot study we evaluated buprenorphine maintenance for the treatment of heroin dependence in a program administered by primary-care providers in a primary-care setting. Seven patients were admitted to this nonblinded open-label pilot study and were offered 6 months of primary-care-based buprenorphine maintenance. Buprenorphine was administered in doses of 16 mg on Monday and Wednesday and 32 mg on Friday. Patients were seen weekly by primary-care providers and attended self-help meetings. Of the seven patients admitted to the study, five (71%) completed the 6-month pilot study and two (29%) were removed from the study. Urine toxicology data showed that the majority of urines tested were clear of opioids in four out of five patients who remained in treatment. These results suggest that primary-care-based opioid maintenance using buprenorphine shows promise as a new approach to the treatment of heroin dependence.
TL;DR: Cocaine abusers from an inpatient drug rehabilitation program were interviewed regarding combined use of cocaine with alcohol or cigarettes and patients experienced decreased craving for cocaine and alcohol during treatment, but craving for cigarettes remained essentially unchanged.
Abstract: Cocaine abusers (N = 42) from an inpatient drug rehabilitation program were interviewed regarding combined use of cocaine with alcohol or cigarettes. Concurrent use of alcohol and cocaine was reported by 37 patients and concurrent use of cigarettes and cocaine by 41 patients. All but two concurrent users reported simultaneous use of alcohol or cigarettes with cocaine. Increased cocaine effect was perceived by 43% of simultaneous alcohol users compared with 15% of simultaneous cigarette users. Patients experienced decreased craving for cocaine and alcohol during treatment, but craving for cigarettes remained essentially unchanged.
TL;DR: It is found that the interaction of parental discipline and difficult temperament in the child moderated both externalizing and internalizing behavior problems, accounting for an additional 5% of an explained variance.
Abstract: We conducted this study with a sample of sons of fathers having a Psychoactive Substance Use Disorder (PSUD+, n = 55) and sons of fathers who did not qualify for a PSUD (PSUD-, n = 97). Parental discipline practice from the child's perspective was investigated in relation to the child's difficult temperament to determine their association with sons' externalizing and internalizing behavior problems reported by mothers. PSUD+ status, difficult temperament in the boys, and their ratings of parental discipline practices accounted for a significant proportion of variance with respect to their externalizing behavior (11%), but only PSUD+ status had a main effect on internalizing behavior. However, the main finding of this study was that the interaction of parental discipline and difficult temperament in the child moderated both externalizing and internalizing behavior problems, accounting for an additional 5% of an explained variance. Thus, this study illustrates the importance of the conjoint influence of children's temperament characteristics and parental discipline practices on the children's adjustment. These results support the findings from previous studies showing that a difficult temperament disposition places the child at risk for maltreatment by parents and for development of a disruptive behavior disorder. Both outcomes have been found in many investigations to presage alcohol and drug abuse in adolescence. The findings also underscore the importance of both individual and contextual variables for understanding the development of psychopathology. In this regard, the results show the need for prevention and treatment to encompass strategies directed at disaggregating the basis of maladaptive family interaction patterns.
TL;DR: Among IDUs who continued to inject drugs at 1 year, men retained in treatment obtained lower scores on the "sharing with others" scale than men not retained, even when controlling for initial scale scores and injection frequency.
Abstract: Using AIDS Initial Assessment questionnaire (AIA) data from 353 injection drug users (IDUs) newly admitted to methadone maintenance (MM), three dimensions of injection risk behavior (“sharing with sexual partner,” “sharing with others,” and “new needle use”) were identified. Among IDUs who continued to inject drugs at 1 year, men retained in treatment obtained lower scores on the “sharing with others” scale than men not retained, even when controlling for initial scale scores and injection frequency. Associations between retention in MM and changes in sexual risk were examined using two AIA measures of sexual risk behavior (“number of IDU sexual partners” and “relative frequency of unprotected vaginal intercourse”). Controlling for injection frequency, prior sexual risk, and age, there was no difference in sexual risk for men retained in treatment versus those not retained. Among women, those who stayed in MM for 1 year reported significantly fewer IDU partners.
TL;DR: Bivariate analyses found that women who accepted treatment were more likely to be African-American, to be single (never married), and to have a significantly greater number of children than women who declined treatment.
Abstract: There is a dearth of substance abuse treatment programs available to pregnant substance-using women. However, even when specialized substance abuse treatment programs are offered to these high-risk women, some women will choose not to enter treatment. To gain a better understanding concerning the characteristics of pregnant substance-using women related to their decisions regarding treatment utilization, this study compares two groups of substance users: 93 pregnant women who accepted offered substance-related treatment services, and 89 pregnant women who declined the same services. All women were interviewed and information was gathered concerning their sociodemographic characteristics, their types and levels of substance use, substance use by their family members, and their experiences of being victims of violence. Bivariate analyses found that, compared to women who declined treatment, women who accepted treatment were more likely to be African-American, to be single (never married), and to have a sign...
TL;DR: This study of all accidental fatal drug overdoses in New York City from 1990 to 1992, using medical examiner data, found that cocaine, often with opiates and ethanol, caused almost three-fourths of deaths, while opiates without cocaine caused roughly one-fourth of fatal overdoses.
Abstract: This study of all accidental fatal drug overdoses (N = 1,986) in New York City from 1990 to 1992, using medical examiner data, found that cocaine, often with opiates and ethanol, caused almost three-fourths of deaths, while opiates without cocaine caused roughly one-fourth of fatal overdoses. Only 5% of accidental drug fatalities were caused by drugs other than cocaine or opiates. This is a marked departure from the results of studies in the early 1980s when opiates prevailed as a cause of accidental fatal overdoses. In this study the highest cocaine overdose rates were found among males, African-Americans, and Latinos. Rates of opiate overdose without cocaine did not differ in regard to race/ethnicity except for low rates among Asians and other ethnic groups. There was a marked increase in the rate of combined cocaine and opiate overdoses from 1990 to 1992 and a more gradual but steady increase of overdoses due to opiates without cocaine during that time period. Overdoses due to drugs other than cocaine or opiates showed no increase during that time period.
TL;DR: Cluster analyses of subsamples that met the DSM-IV criteria for dependence or abuse for alcohol, cocaine, marijuana, and opiates found that the Type A/Type B distinction was largely generalizable across drugs.
Abstract: Previous research using cluster analysis has found that abusers of both alcohol and cocaine can be categorized into more severe (Type B) and less severe (Type A) subgroups. This article sought to replicate and extend these findings in a sample of 521 inpatients, outpatients, and nontreatment-seeking abusers of alcohol, cocaine, marijuana, and opiates. Cluster analyses of subsamples that met the DSM-IV criteria for dependence or abuse for alcohol, cocaine, marijuana, and opiates found that the Type A/Type B distinction was largely generalizable across drugs. Type As—who consistently accounted for about 60% of all substance abuse and about half of abusers in treatment—scored lower than Type Bs on a variety of substance abuse and psychiatric measures that were administered both at intake and at a 6-month follow-up.
TL;DR: Women for Sobriety represents a self-help option oriented toward positive thinking and behavior modification, so the program teaches members that maintaining sobriety must involve the realization that negative emotions are destructive-and that members can control how much they allow problems to bother them.
Abstract: Women for Sobriety represents a self-help option oriented toward positive thinking and behavior modification. Formed in 1975, there are now approximately 125 active WFS groups holding weekly meetings in the United States and Canada. Using data collected from a 1991 membership survey (n = 600, response rate = 73%), this paper chronicles WFS members' pathways to recovery. We describe turning points in seeking help, things women tried at first to contain their drinking, exposure to other treatment approaches, and referrals to WFS from formal treatment programs. Only 15% of the respondents sought treatment because they had been confronted about their drinking, while physical symptoms or emotional problems represented the turning point for over half the women. Another fifth said their life had gotten out of control, and these were the ones to achieve sobriety most quickly. Almost all WFS members had sought professional help for their drinking, and three-fourths have undergone individual therapy-suggesting that WFS members are fairly open to a psychological approach such as WFS offers. WFS philosophy is based on the belief that behavior is predicated on thoughts, so the program teaches members that maintaining sobriety must involve the realization that negative emotions are destructive-and that members can control how much they allow problems to bother them. Goals of membership include abstinence, improved self-esteem, and spiritual and emotional growth. About a third of the respondents currently attend AA, and no differences in length of sobriety associated with current AA attendance were found within the WFS membership. However, women who sought professional help in response to the turning point experience but who also attended AA that year were most likely to have achieved sobriety within a year of the turning point.
TL;DR: Those in the Johnson Intervention group were more likely to relapse than three of the four other groups and, across all groups, those who relapsed were less likely to complete treatment.
Abstract: The Johnson Intervention is a therapeutic technique in which members of a person's social network confront him or her about the damage that drinking and drug use has caused and the action they will take if he or she does not enter treatment. Previously, we evaluated the effectiveness of the Johnson Intervention at engaging and retaining clients in outpatient alcohol and other drug (AOD) treatment by comparing it to four other methods of referral. Although individuals who undergo a Johnson Intervention are most likely to enter treatment, the power of the Johnson Intervention to retain clients deteriorates over the course of treatment, as indicated by their diminished likelihood of completing. Given that abstinence from alcohol and other drugs is one of the first expectations placed on clients, we compared the Johnson Intervention to the other types of referral to evaluate the role of relapse during treatment. In a secondary analysis of 210 cases, we found relapse rates across the five types of referral ranged from 38% to 79%. Those in the Johnson Intervention group were more likely to relapse than three of the four other groups and, across all groups, those who relapsed were less likely to complete treatment. In spite of its high relapse rate, the Johnson Intervention is very effective in retaining those who relapse because it is very effective retaining all clients, whether they relapse or not.
TL;DR: The intention of this article is to critically review the literature in psychiatric epidemiology and clinical psychiatry and to offer suggestions as to how the strengths from each could be applied in a comprehensive research approach.
Abstract: Research on familial factors in illicit drug abuse has been approached from the perspectives of psychiatric epidemiology, which aims to assess familial clustering of disorders, and clinical psychiatry, which focuses on intrafamilial dynamics. To date, however, these two research traditions have existed in relative isolation from each other, and there has been little consideration given to enhancing the understanding of familial factors in drug abuse by combining these approaches. The intention of this article is to critically review the literature in these two areas and to offer suggestions as to how the strengths from each could be applied in a comprehensive research approach.
TL;DR: Clinical and practical aspects of treatment of opiate addiction with a relatively new approach, rapid opiate detoxification (ROD), and ROD appears to be a valuable tool in the treatment of heroin addiction.
Abstract: We report on clinical and practical aspects of treatment of opiate addiction with a relatively new approach, rapid opiate detoxification (ROD). The goal is to induce rapid narcotic withdrawal in a controlled environment using narcotic antagonists while suppressing withdrawal symptoms with sedative drugs, thus effecting a dramatic abbreviation of the traditional withdrawal schedule. Twenty-five consecutive heroin-addicted patients presenting for detoxification were treated at a university hospital. There were 14 women and 11 men, with a mean age 32.6 years (range, 24-48). They underwent 29 separate detoxifications over a 4-month period. All but 3 of the detoxifications were effected with ROD. Several different techniques were used over the 4-month period, ranging from intramuscular and oral sedation to intravenous sedation, paralysis, and intubation. Efficacy of detoxification was demonstrated for all patients undergoing ROD; all were given 50 mg of naltrexone PO prior to discharge, and none had withdrawal symptoms. (The three patients treated with abstinence were not so tested.) We derive three conclusions from this early clinical experience: First, ROD appears to be a valuable tool in the treatment of heroin addiction. ROD is an efficient, effective technique that can play an important role in an integrated rehabilitation program. Second, the optimal method of ROD is yet to be determined; a continuum of approaches is available. Third, ROD is probably most suited to designated outpatient centers.
TL;DR: Although group confrontation techniques were used, schizophrenics and patients with major depressive disorder experienced an outcome as good or better than the less impaired on retention, visit rates, and urinalysis results.
Abstract: Large numbers of indigent cocaine abusers now present in center-city hospitals. Since many are also diagnosed for severe mental illness, options for their effective treatment are needed. The authors investigated the feasibility of treating these dually diagnosed patients along with the majority of abusers who were not severely impaired in a program that combines peerled treatment with psychiatric management and pharmacotherapy. Although group confrontation techniques were used, schizophrenics (N = 71) and patients with major depressive disorder (N = 50) experienced an outcome as good or better than the less impaired (N = 177) on retention, visit rates, and urinalysis results.
TL;DR: It was found that greater earlier marijuana use and greater earlier alcohol use predicted, to a significant degree, poorer occupational performance.
Abstract: This report is from a longitudinal study of a community sample of African-American males (N = 197) on the relationship of the degree of earlier substance use/abuse up to average age 24, to vocational performance (employment and occupational level) 2 1/2 years later (at average age 26 1/2). The statistical analyses included numerous control variables developed from prospective data of the National Collaborative Perinatal Project, on the subjects and on their families from the subjects' birth to age 7, and from their school behavior and academic performance up to age 16, which may have influenced their vocational-occupational behavior during early adulthood. It was found that greater earlier marijuana use and greater earlier alcohol use predicted, to a significant degree, poorer occupational performance.
TL;DR: The two disciplines of psychiatry and law follow their own modes in resolving issues in alcoholism and other substance abuse and need research and new approaches to build a bridge between the two.
Abstract: Objective: The purpose of this article is to discuss the interface between judicial discipline and behavioral science in the context of substance-related disorders. Method: We review the epidemiology of psychoactive drug use and crime and discuss the courts' decisions on relevant landmark cases, particularly as they influence the practice of psychiatry. Results: (1) The phenomenology of addiction and crime is of great epidemiological import. (2) Our legal system inclines toward the view that the use of alcohol or other substances involves an element of choice and therefore would not amount to a legal insanity defense if the substance abuser commits a crime while intoxicated. (3) A state can confine an addict or alcoholic for compulsory treatment if that individual presents a danger to self or others. (4) The law has found that alcoholism and drug abuse are both “willful misconduct” and a disabling condition; the former definition contains the end in view of punitive action. The latter is aimed toward trea...
TL;DR: Postinjury abuse of AODA is particularly important with regard to the disruption of the rehabilitation process and use of adequate control groups and analysis at multiple postinjury time points is recommended in future investigations.
Abstract: Alcohol and other drugs of abuse (AODA) are of great medical and social concern. Patients with physical injury requiring rehabilitation may be at particular risk of AODA due to pain, physical handicaps, mood disturbances, vocational difficulties, and problems of self-image. Their access to AODA, however, is often temporarily or permanently limited. In this literature review, we have explored various aspects of AODA in physically disabled patients. Frequently, AODA are involved in the cause of physical injuries. The average use and abuse of alcohol prior to injury was high. Postinjury alcohol use and abuse frequently declined or remained unchanged. Some non-alcohol drug use and problems increased postinjury, particularly during initial periods. Postinjury abuse of AODA is particularly important with regard to the disruption of the rehabilitation process. Use of adequate control groups and analysis at multiple postinjury time points is recommended in future investigations.
TL;DR: Early post-binge period was dominated by psychoticism and agitation, followed by recovery for the duration of the period assessed, and principal components analyses extracted four factors accounting for 64% of the variance: psychoticism, exhaustion, agitation, recovery.
Abstract: We assessed cocaine abstinence symptomatology in a sample of 100 cocaine-abusing, methadone-maintained patients who completed an anonymous questionnaire retrospectively rating the intensity of 18 symptoms at six time points, from 30 minutes to 2 weeks, post-cocaine use. We found that a majority of patients endorsed symptoms related to dysphoria 24 hours post-binge. However, these symptoms tended to be mild to moderate in intensity and relatively short-lived. Principal components analyses extracted four factors accounting for 64% of the variance: psychoticism, exhaustion, agitation, recovery. Early post-binge period was dominated by psychoticism and agitation, followed by recovery for the duration of the period assessed.
TL;DR: Interestingly, patients with an opioid diagnosis engaged in more treatment during the follow-up period, suggesting cocaine-dependent patients with a coexisting opioid use disorder may constitute a subgroup with worse prognostic characteristics, for whom differential treatments may improve outcome.
Abstract: This study was undertaken to compare cocaine-dependent patients with and without an opioid use disorder, in an effort to identify important clinical similarities and differences between the two groups. Ninety patients hospitalized for cocaine dependence were divided according to whether or not they had a coexisting opioid use disorder; 32 patients (35.6%) had an opioid diagnosis and 58 (64.4%) did not. The groups were compared on substance use histories, psychopathology, severity of drug-related problems, and 3-month cocaine use outcome. Patients with an opioid diagnosis had more current major depression, antisocial personality disorder, and other substance use disorders. They also had higher medical and drug scores on the Addiction Severity Index, and longer cocaine use histories. Nonetheless, 3-month cocaine use outcome was similar for both groups. Interestingly, patients with an opioid diagnosis engaged in more treatment during the follow-up period. Cocaine-dependent patients with a coexisting opioid u...
TL;DR: Techniques and case material are presented to illustrate how a therapist first "establishes a secure base" and then transitions to "facilitating exploration" in substance abuse psychotherapy.
Abstract: Psychotherapy with addicted individuals often involves a shift in therapeutic techniques during the transition from early to later recovery treatment. A conceptual model based in attachment theory can provide a rationale and framework for this shift in the treatment of some addicted persons. Techniques and case material are presented to illustrate how a therapist first “establishes a secure base” and then transitions to “facilitating exploration.” An active, directive, supportive, and educative therapeutic approach that deemphasizes exploratory work in early recovery helps the patient achieve abstinence and develop a sense of security and attachment with the therapist. This sense of therapeutic security combined with ongoing abstinence permits a shift to a more nondirective, expressive therapeutic stance that facilitates the exploratory work of later recovery. Working through these issues in the therapeutic transition provides an excellent opportunity to examine the interpersonal and emotional difficultie...