Showing papers in "American Journal of Drug and Alcohol Abuse in 1997"
TL;DR: The present findings support clinical observations that adolescent drug abusers are less motivated to change or ready for treatment than adults; and they confirm the importance of motivational and readiness factors in the treatment process, regardless of age.
Abstract: A growing body of research has demonstrated the importance of motivation and readiness among drug abusers in seeking, complying with, and remaining in treatment. To date, however, there is little r...
169 citations
TL;DR: Findings support the TC perspective that the substance abuse problem is the person, not the drug of choice, and are consistent with prior research emphasizing the importance of dynamic rather than fixed variables as determinants of retention.
Abstract: There is currently little empirical research on the effect of motivation and readiness on the treatment of different groups of substance abusers In the present study, the CMRS scales are used to assess motivation and readiness for treatment of a large sample of primary alcohol, marijuana, heroin, cocaine, and crack cocaine abusers admitted to a long-term residential therapeutic community Findings show few significant differences in overall retention or initial motivation and readiness Initial motivation and readiness scores persist as significant predictors of short-term retention in treatment across most groups Findings support the TC perspective that the substance abuse problem is the person, not the drug of choice, and are consistent with prior research emphasizing the importance of dynamic rather than fixed variables as determinants of retention
133 citations
TL;DR: The high rate of domestic violence and the strong association between childhood and partner abuse found in this study suggest areas for intervention in chemical dependency among women.
Abstract: This study examines the relationship between childhood abuse and partner abuse among a sample of predominantly African-American and Hispanic women, who were patients in methadone clinics in Harlem and the South Bronx. A structured questionnaire addressing demographics, psychosocial and physical health characteristics, depression, childhood abuse, and domestic violence was administered to 151 women. Over half of the women (60%, n = 98) reported lifetime physical, life-threatening, or sexual abuse by a spouse or boyfriend. Multiple logistic regression analysis was used to assess the associations between childhood physical abuse and abuse by a spouse or boyfriend and between childhood sexual abuse and abuse by a spouse or boyfriend. After controlling for potential confounders, women who reported childhood physical abuse were almost nine times more likely to report having been abused by a spouse or boyfriend (OR = 8.74, CI, = 3.25 to 23.57). Women who reported childhood sexual abuse were almost four times more likely to report having been abused by a spouse or boyfriend (OR = 3.93, CI = 1.46 to 10.59). Depression and need for social support were significantly associated with partner abuse, while current heroin use was inversely associated with partner abuse. The high rate of domestic violence and the strong association between childhood and partner abuse found in this study suggest areas for intervention in chemical dependency among women.
104 citations
TL;DR: This study summarizes historical changes among clients entering drug treatment in their sociodemographic characteristics and important pretreatment behaviors, such as work activity, criminal behavior, drug use, prior drug treatment, and health insurance.
Abstract: This study summarizes historical changes among clients entering drug treatment in their sociodemographic characteristics and important pretreatment behaviors, such as work activity, criminal behavior, drug use, prior drug treatment, and health insurance. Data are drawn from three major studies of drug abuse treatment clients: the Drug Abuse Reporting Program (DARP), 1969–1972; the Treatment Outcome Prospective Study (TOPS), 1979–1981; and the Drug Abuse Treatment Outcome Study (DATOS), 1991–1993. The mix of drug treatment clients and their interaction with the drug treatment system changed substantially over the past three decades. Because data items are most directly comparable between TOPS and DATOS, the focus of this paper is on changes within the past decade. The most conspicuous change is in types and numbers of drugs used by clients entering treatment. Multiple drug use declined since the late 1970s, while reports of cocaine use since TOPS more than doubled among clients in the long-term residential...
103 citations
TL;DR: It is demonstrated that cessation or continuation of cocaine use after entry into methadone maintenance treatment is not uniform across different types of cocaine.
Abstract: This paper reports on the patterns of cocaine use among subjects (N = 427) admitted to a methadone maintenance treatment demonstration project designed to reduce risk for HIV. Assessments were conducted at intake and at approximately 18-24 months after treatment admission. Self-reported data on cocaine use was compared with results of urinalysis tests at both intake and follow-up; 29 subjects who falsely reported no use were recorded as users. Over one-third used some form of cocaine at both intake and follow-up, while approximately 30% abstained at both points. Approximately 20% ceased as well as initiated cocaine use between intake and follow-up. Use of powder cocaine, either alone or combined with heroin in "speedballs," decreased at follow-up, whereas crack use increased. Discriminant function analyses were performed to determine the predictors of the different patterns of cocaine use by type. Receipt of enhanced methadone treatment compared with standard methadone treatment, treatment duration, or average duration of counselor contact appeared unrelated to cocaine use. Cocaine use at follow-up was associated with polydrug and alcohol use, illegal activity, a negative emotional state, and sex work. Crack users were more likely to be African American than nonusers; continuous users of powder cocaine were more likely to also be using heroin than were nonusers; and continuous speedball users were more likely to be women sex workers with high levels of depression. This analysis demonstrated that cessation or continuation of cocaine use after entry into methadone maintenance treatment is not uniform across different types of cocaine.
96 citations
TL;DR: An observational study with validation of multivariable results of data collected by interview from persons presenting for addictions treatment in the public system who reported having a physician finding forty-five percent of patients with substance abuse serious enough to prompt a presentation for treatment stated that the physician who cared for them was unaware of their substance abuse.
Abstract: Purpose: To describe and assess the prevalence of perceived physician unawareness of serious substance abuse. Patients and methods: We report an observational study with validation of multivariable results of data collected by interview from persons presenting for addictions treatment in the public system who reported having a physician. Results: Of 3,253 patients interviewed, 87% (2,843) responded to the question about having a physician. Of 1,440 patients who stated that they had physicians, 45% (651) reported that the physician who cared for them was unaware of their substance abuse. In multivariable logistic regressions adjusting for sociodemographics, health status, and substance abuse histories, the following patient characteristics were found to be independently associated with physician unawareness of substance abuse and were confirmed in a validation analysis (OR = Odds Ratio, CI = 95% Confidence Interval): no prior episodic medical illness (OR = 1.98, CI = 1.35-2.92), no health insurance (OR = 1...
88 citations
TL;DR: The logistic regression model confirmed that there is a significant relationship between an AMA event and the presence of benzoylecgonine in urine upon beginning detoxification and to a shorter duration of the period of total heroin abstinence.
Abstract: Detection of benzyolecgonine, the major metabolite of cocaine, in the urinalysis conducted on the first day of an inpatient heroin detoxification treatment program was studied as a predictor of discharge against medical advice (AMA). With this aim, we conducted a chart-review procedure of 275 heroin dependents (DSM-III-R) who received methadone or dextropropoxyphene chlorhydrate to treat Opioid Withdrawal Syndrome. Data were analyzed following a case-control design. The 49 (17.8%) patients who did not complete the treatment due to discharged AMA were characterized by having achieved total heroin abstinence during fewer months from the time they began consumption of this substance to the time of hospitalization (p = .001). Moreover, those patients who requested discharge AMA were characterized by more frequent detection of benzoylecgonine in their urine on the day of admission (p = .004). The value of the odds ratio of this association was 3.81 (95% CI; 1.30 to 11.04). Lastly, noncompleters due to discharge AMA were more likely to be single than ever married (p = .037). The logistic regression model confirmed that there is a significant relationship between an AMA event and the presence of benzoylecgonine in urine upon beginning detoxification and to a shorter duration of the period of total heroin abstinence. In the discussion, the influence that recent interruption of cocaine consumption has on the decision to drop out of a detoxification program AMA is considered.
68 citations
TL;DR: It is suggested that mortality rates of overdoses involving cocaine and optiates are significantly associated with the poverty status of communities in New York City.
Abstract: This ecological study examines the association of the poverty status of urban communities in New York City with their mortality rates of accidental drug overdoses Mean annual age-adjusted rates of drug overdoses involving cocaine, opiates, or both (n = 1,684) were calculated for each of 59 residential community districts in New York City for 1990-1992 A linear regression analysis was performed to test the association of the mortality rate with the poverty status of the district as measured by the proportion of the district living below the 1989 US poverty line Poverty status accounted for 69% of the variance in the drug overdose mortality rates of communities (p < 001) This study suggests that mortality rates of overdoses involving cocaine and optiates are significantly associated with the poverty status of communities in New York City
66 citations
TL;DR: Findings from the evaluation of the Los Angeles Target Cities Enhancement Project indicate that the Target Cities programs successfully increased client participation in group and individual counseling-an increase that cannot be attributed to client characteristics.
Abstract: Increasing the opportunity for group and individual counseling in outpatient drug treatment programs could increase client participation in counseling which, in turn, may enhance program effectiveness Findings from the evaluation of the Los Angeles Target Cities Enhancement Project indicate that the Target Cities programs successfully increased client participation in group and individual counseling-an increase that cannot be attributed to client characteristics Further, the magnitude of the increase in group and individual counseling was sufficient to increase the overall effectiveness of Target Cities programs These findings support the widely held contention among drug treatment providers and policy makers that frequent counseling is necessary for treatment success They suggest that counselors and other service providers should encourage and facilitate frequent participation in group and individual counseling Most importantly, the findings indicate that increasing the opportunity for group and ind
63 citations
TL;DR: Comparisons showed that demographically similar, crack users reported more sexual partners in the last 12 months, more sexually transmitted diseases (STDs) in their lifetime, and greater frequencies of paying for sex, exchanging sex for drugs, and having sex with injection drug users.
Abstract: Background: Increasing rates of sexually transmitted diseases among users of noninjection drugs prompt speculation that crack cocaine users who do not inject are at particularly high risk of HIV (human immunodeficiency virus) infection. Methods: A street recruitment technique was employed to enroll 331 primarily African-American men aged 18–29 in an area of San Francisco where crack cocaine is sold openly. One-half were regular crack users, and the other half had never used the drug. Few reported injection drug use or male-to-male sex. In a face-to-face interview, participants reported on their drug use, knowledge of HIV, sexual practice, condom use, and demographic characteristics. Following counseling, each was tested for HIV and syphilis. Results: Comparisons showed that demographically similar, crack users reported more sexual partners in the last 12 months, more sexually transmitted diseases (STDs) in their lifetime, and greater frequencies of paying for sex, exchanging sex for drugs, and having sex ...
62 citations
TL;DR: In this article, the authors used the National Household Survey on Drug Abuse (NHSODA) to examine mental health consequences and treatment utilization among non-metropolitan and rural adults.
Abstract: This study uses the National Household Survey on Drug Abuse to examine mental health consequences and treatment utilization among nonmetropolitan and rural adults. The study employs an ecological system perspective, dividing the study population into three groups: nonmetropolitan-rural, nonmetropolitan-urban, and metropolitan-rural. Logistic regression analysis is used to examine four sets of factors related to self-report of mental health problems among drug-using adults, including community level features, family characteristics, personal characteristics, and stress factors. Perceived ease of purchasing cocaine, number of moves in last five years, employment in blue-collar occupations, number of jobs in last five years, and residence in neighborhoods with a low rate (< 10%) of minority households were significantly related to self-report problems. Results of the analysis are discussed in terms of barriers to utilization of treatment and rehabilitation services among nonmetropolitan and rural adults, such as availability and access to facilities and professional services, social stigma, ability to afford services, and the difficulty for rural communities to support inhospital and outpatient services.
TL;DR: The results suggest that the POSIT can serve as a useful first-gate instrument to identify adolescents in need of further drug abuse assessment and if a shortened scale could be developed and yet retain acceptable classification accuracy.
Abstract: Recent research has indicated high rates of substance abuse among adolescents with emotional and behavioral disorders. Moreover, adolescents in clinical and correctional settings found to have comorbid disorders involving substance abuse experience higher morbidity and mortality rates when compared to adolescents having one or no condition. The present study examines the ability of the Problem-Oriented Screening Instrument for Teenagers (POSIT) to identify DSM-III-R-defined psychoactive substance use disorders among 342 adolescents aged 12-19 years. Participants were sampled from school, clinical, and correctional settings. Optimal-scale cut scores for drug abuse diagnosis classification were derived by a minimum loss function method that minimized false classifications. When using the optimal cut score of two for the total sample, the standard POSIT substance use/abuse scale obtained a drug abuse diagnosis classification accuracy of 84% with sensitivity and specificity ratios of 95% and 79%, respectively. The internal validity of the standard 17-item substance use/abuse scale was subsequently examined by principle component analysis, item analysis, and coefficient alpha. The internal validity analyses were conducted to determine if a shortened scale could be developed and yet retain acceptable classification accuracy. When using the optimal cut score of two for the total sample, the revised 11-item scale obtained a drug abuse diagnosis classification accuracy of 85% with sensitivity and specificity ratios of 91% and 82%, respectively. The results suggest that the POSIT can serve as a useful first-gate instrument to identify adolescents in need of further drug abuse assessment.
TL;DR: This paper presents the results of implementing on-site alcohol or drug (AOD) brief intervention services across several medical, surgical, and psychiatric services in a county hospital that included patient substance abuse assessment, feedback to patient, and referral/recommendations.
Abstract: This paper presents the results of implementing on-site alcohol or drug (AOD) brief intervention services across several medical, surgical, and psychiatric services in a county hospital. These integrated brief interventions (IBI) included patient substance abuse assessment, feedback to patient, and referral/recommendations. Three hundred sixty-three patients were referred by hospital staff to these services and 95% of these patients were subsequently confirmed by chemical dependency specialists as having diagnoses of psychoactive substance abuse or dependence. Seventy-nine percent of chemically dependent patients were without current substance abuse treatment, even though 54% were partially motivated and 20% were fully motivated for getting treatment. Of patients contacted at follow-up, 35% reported involvement in some kind of substance abuse treatment or 12-step meetings. Implications for implementing integrated brief intervention services are discussed in light of recent trends in publicly funded treatment availability and brief intervention outcome studies.
TL;DR: There was no significant correlation between thetype of substance abuse diagnosis and the type of crime committed, and the number of individuals who reported they were acutely intoxicated with one or more substances at the time of the offense and the types of crimes committed.
Abstract: The present study investigated the relationship between crime and substance abuse in a sample of 133 consecutively evaluated male prisoners. Using the Structured Clinical Interview for DSM-III-R, we assessed the prevalence of various forms of substance abuse in this population and attempted to judge whether substance abuse played a role in the index crime which has led to the present incarceration. In addition, we assessed whether there was a relationship between the nature of substance dependence and the type of crime committed, whether sexual, violent, or non-violent. Among the 133 prisoners, 95% obtained a diagnosis of dependence on one or more substances. Fifty-eight percent of the inmates reported that they were acutely intoxicated with one or more substances at the time they committed the index crime and an additional 6% were withdrawing from a substance at the time of the crime. There was no significant correlation between the type of substance abuse diagnosis and the type of crime committed. Similarly, there was no significant correlation between the number of individuals who reported they were intoxicated at the time of the offense and the type of crime committed.
TL;DR: The psychometric structure and characteristics of the adult version of the Drug Use Screening Inventory were examined in alcohol and drug abusers and normal controls and demonstrate that the DUSI is a practical and psychometrically sound screening instrument.
Abstract: The psychometric structure and characteristics of the adult version of the Drug Use Screening Inventory were examined in alcohol and drug abusers (n = 119) and normal controls (n = 119). It was found that each of the 10 DUSI domains is unidimensional. Inter-item, split half and internal reliability ranged from good to excellent. A score of 4 or higher on the Substance Use Domain correctly classified 80% of the substance abusers whereas a score of 3 or less accurately detected 100% of the normal control subjects. These results demonstrate that the DUSI is a practical and psychometrically sound screening instrument.
TL;DR: Findings supported previous findings suggesting that increased self-efficacy regarding resisting drug use is associated with lower rates of drug use during treatment, and that self- efficacy enhancement may be an important intervention in the treatment of cocaine use.
Abstract: The perceived ability to engage in situation-specific behaviors (self-efficacy) to overcome nicotine dependence and alcohol abuse has been shown to correlate significantly with and be predictive of the actual ability to engage in such behaviors. Self-efficacy is also related to subsequent behavior change during treatment and maintenance of this change after treatment termination. In this study, part of national outcome study, the relationship between self-efficacy and drug use was investigated in a subsample of regular cocaine users (n = 294) who completed at least three months of treatment in community-based outpatient treatment programs. Frequency of cocaine and other drug use was reported for the period of 1 year before treatment and a 1 month and 3 months in treatment. Self-efficacy regarding resisting drug use was measured at 1 and 3 months in treatment. Self-efficacy at 1 month was correlated with cocaine use at 1 month and self-efficacy contributed to the prediction of self-reported drug use at 1 month over and above pretreatment and demographic variables. Similarly, self-efficacy at 3 months was correlated with cocaine use at 3 months and contributed to the prediction of self-reported drug use at 3 months. These outcomes were obtained even though over 75% of subjects reported no drug use during treatment. The results supported previous findings suggesting that increased self-efficacy regarding resisting drug use is associated with lower rates of drug use during treatment, and that self-efficacy enhancement may be an important intervention in the treatment of cocaine use.
TL;DR: The study results document the extreme heterogeneity in the dually diagnosed as well as their multiple treatment needs, and future research on dual diagnosis should attempt to establish meaningful subgroups relevant to service needs and should utilize diverse clinical and functioning measures.
Abstract: The study provides descriptive data on a large, diverse sample of dually diagnosed patients from an urban psychiatric inpatient setting, utilizing a comprehensive array of clinical, social and comm...
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TL;DR: Gamma-hydroxybutyric acid is an allegedly benign illicit substance that is gaining increasing recognition and attention among substance abusers and athletes and sold as a health product, often used with a false sense of security as it may cause serious and disabling complications.
Abstract: Gamma-hydroxybutyric acid is an allegedly benign illicit substance that is gaining increasing recognition and attention among substance abusers and athletes. Alongside foreign-made brands, the compound is also easily available, at low cost because of the facility with which it can be produced in one's kitchen. Named by some “Nature's Quaalude” or sold as a health product, it is often used with a false sense of security as it may cause serious and disabling complications, as illustrated by this clinical vignette.
TL;DR: Results indicated that increases in alcohol consumption were associated with increased drinking consequences for white men, but increased consumption had little affect for black men, and suggest that liberal drinking norms may have greater long term consequences for black than white men.
Abstract: We examined increases in self-reported alcohol-related problems among black and white adult drinkers using data from the 1984 and 1992 National Alcohol Surveys. The objectives of the study were to determine whether alcohol consumption, drinking norm, or socioeconomic status were related to increases in alcohol-related problems. Two types of self-reported alcohol-related problems were analyzed using regression methods: drinking consequences and alcohol dependence symptoms. Results indicated that increases in alcohol consumption were associated with increased drinking consequences for white men, but increased consumption had little affect for black men. Changes in drinking norms regarding non-social drinking were associated with increased in drinking consequences among black men, such norms showed little affect on drinking consequences for white men. Despite substantial increases in alcohol consumption among black women from 1984 to 1992, there were no significant racial/ethnic differences in drinking consequences or alcohol dependence symptoms among women. Changes in socioeconomic status were however related to increases in drinking consequences and alcohol dependence symptoms in women, but not in men. Findings suggest that liberal drinking norms may have greater long term consequences for black than white men. Socioeconomic status, on the other hand, may have greater explanatory power in predicting increases in alcohol-related problems in women than in men.
TL;DR: The findings indicate that parent/child alcohol use transmission is more gender specific than race specific; fathers' drinking tends to affect sons' drinking and mothers' drinking tend to affect daughters' drinking.
Abstract: A structural model on parent/adult-child alcohol use patterns was examined. Three analytical blocks were specified: adult-children's alcohol use onset by types of alcoholic beverage, their current use of these alcoholic beverages, and parents' drinking patterns. The model was examined with data collected from drunken driving offenders in California and Maryland treatment programs. The findings indicate that parent/child alcohol use transmission is more gender specific than race specific; fathers ‘drinking tends to affect sons’ drinking and mothers' drinking tends to affect daughters' drinking. Beer use onset is the earliest and more effective in influencing future alcohol use than the onset of wine or liquor.
TL;DR: Lifetime substance abuse or dependence appears to have an adverse association with survival after bone marrow transplant when other clinical factors are equal, and reduced survival times for patients with SA.
Abstract: The purpose of this retrospective study is to test the hypothesis that lifetime substance abuse has an adverse impact on survival after bone marrow transplant (BMT). This study included 17 of 468 patients admitted to the Bone Marrow Transplant Unit at the Brigham and Women's Hospital in Boston, Massachusetts who were identified to have lifetime substance abuse (SA). Seventeen comparison subjects were selected from the admissions roster if they matched for disease and stage, type of transplant, pretransplant conditioning regimen, and age, but did not have SA. The medical records of all 34 patients were then reviewed by expert substance abuse clinicians for confirmation of SA and course of transplant. Survival time was calculated from the date of BMT admission to the date of last contact. Survival data were analyzed through Kaplan Meier survival curves and log rank tests for association of survival time with lifetime SA, both before and after stratification for history of cigarette smoking and type of transplant. The patients with and without SA were well matched for all clinical factors. Substance abuse or dependence was confirmed in all 17 patients, with alcohol (71%), marijuana (30%), and opiates (30%) identified as the principal substances of abuse. Survival analysis demonstrated reduced survival times for patients with SA, p = .0022. This difference persisted after stratifying for type of transplant and cigarette smoking. Trends in different survival times by type of transplant (p = .054) and by history of cigarette smoking (p = .07) were also identified. Lifetime substance abuse or dependence appears to have an adverse association with survival after bone marrow transplant when other clinical factors are equal.
TL;DR: The heterogeneous character of the drug using population in relation to aggression is strongly indicated, and the variability between subculturally defined subgroups requires detained ethnographic field studies in the future to describe the contexts of substance use and aggressive behavior.
Abstract: Few comparative studies exist examining the relationship between substance abuse and aggressive behavior under different social conditions. We studied the relationship between aggressive crime and substance abuse among Mexican-American, black and white male arrestees in Dallas, Houston, and San Antonio, Texas using existing 1992 Drug Use Forecasting (DUF) data. The aim of the analysis was to predict the outcome of aggressive crime from drug and alcohol-related and ethnic group variables within the total male sample (n = 2,364). Results indicated that ethnicity was significantly related to aggressive crime. Mexican-American arrestees were more likely to be arrested for aggressive crimes than either blacks or whites. Drug and alcohol use effects were found across all ethnic groups. In general, the subgroup which drank frequently and tested positive for drug use was less likely to be charged with aggressive crimes than the other subgroups. The psychopharmacological influence of alcohol as a disinhibitor and drugs as a inhibitor provides one explantation of the results. Specific ethnic subcultural and ecological influences also affect the outcome. Our study strongly indicates the heterogeneous character of the drug using population in relation to aggression. The variability between subculturally defined subgroups requires detained ethnographic field studies in the future to describe the contexts of substance use and aggressive behavior.
TL;DR: Understanding concepts and processes associated with the concurrent experiencing of recovery and parenthood will be useful to all disciplines that seek to improve the health of mothers, infants, and families.
Abstract: The purpose of this study was to explore women's concurrent experiences of alcohol/drug recovery and transition to parenthood The study used a qualitative design to explore and understand women's experiences of recovery from alcohol/drug dependence during pregnancy and early parenting Observation, diary entries, and intensive interviews were used for data collection from a purposive sample Eleven women, who self-identified as recovering alcoholics/addicts and were either pregnant or had an infant younger than 12 months, participated in the study Findings from descriptive analyses were compared with concepts in the literature about the processes of alcohol/drug recovery, relapse prevention and transition to motherhood Balancing emerged as the core concept, a process that explained how women successfully integrated the recovery and motherhood processes into their identity The women used strategies learned in the process of alcohol/drug recovery to balance between alcohol/drug recovery and motherhood A part of balancing was the use of the protecting strategy in unique ways during pregnancy and early parenting to safeguard both recovery and motherhood Understanding concepts and processes associated with the concurrent experiencing of recovery and parenthood will be useful to all disciplines that seek to improve the health of mothers, infants, and families This study demonstrates the complexity of the women's experiences and suggests implications for practice, theory, research, and policy
TL;DR: No significant differences were found between men and women in patterns of drug use, but more men than women reported heavy drinking and a higher proportion of men thanWomen reported violence in the events related to their arrest.
Abstract: This paper examines differences between men and women in the relationship of alcohol and drug use to criminal offenses, including violent behavior. A probability sample of men (N = 959) and women (N = 188) arrestees were interviewed in a northern California county. No significant differences were found between men and women in patterns of drug use, but more men than women reported heavy drinking. A higher proportion of men than women reported violence in the events related to their arrest (p ⩽. 02). Logistic regression examined the relationship of heavy drinking and violent offenses, controlling for drug use and demographic variables. Frequent heavy drinking (OR = 1.47), white ethnicity (OR =. 51), and being married (OR = 1.93) were significant; gender was not significant. The results have implications for future research on gender and violence.
TL;DR: Test-retest reliability was excellent for lifetime alcohol and cocaine dependence and was substantial for lifetime marijuana and other opiates dependence, indicating that lifetime psychoactive substance abuse diagnoses can be obtained fairly reliably over the telephone using trained lay interviewers.
Abstract: The test-retest reliability of lifetime substance abuse and dependence diagnoses obtained by telephone interviewers was investigated. Trained personnel administered two identical interviews based on a modified Diagnostic Interview Schedule-Substance Abuse Module (DIS-SAM) approximately a week apart for 100 respondents, of whom 55 were receiving alco-
TL;DR: Results indicated that treatment retention for these subjects was similar to that of a sample of individuals who arrived for intake as scheduled, which support the value of outreach efforts as a means of engaging substance-abusing individuals who otherwise might not have experienced treatment.
Abstract: The present study was conducted to evaluate the efficacy of an outreach strategy designed to engage substance-abusing individuals who did not keep their initial treatment appointment. After missing their first scheduled appointment, telephone contact was attempted for 267 consecutive prospective patients as part of an attempt to engage them in treatment. Results indicated that this telephone contact was useful at prompting these individuals to both reschedule and arrive for intake. Our concern that persons who failed to keep initial appointments might be less motivated for treatment was not supported, as results indicated that treatment retention for these subjects was similar to that of a sample of individuals who arrived for intake as scheduled. These results support the value of outreach efforts as a means of engaging substance-abusing individuals who otherwise might not have experienced treatment.
TL;DR: Participants' partners but not the male participants themselves, experienced an increase in marital satisfaction from pre- to within-treatment when the participant was motivated to come to treatment by his partner.
Abstract: This study examines sources of motivation to seek treatment. Participants were 105 male alcoholics and their non-alcoholic female partners who participated in a study of three different approaches to the conjoint treatment of alcoholism. Participants' sources of motivation were coded from responses to questions at the initial clinical screening interview. Sources of motivation were classified as "internal" or "external." More participants had internal sources of motivation (74%) than external sources. Participants with internal sources of motivation scored higher on the Michigan Alcoholism Screening Test than participants with external sources of motivation, but did not differ on other measures of pretreatment severity of alcohol problems. About half of the participants (53%) cited their partner as a primary source of motivation to seek treatment. Other sources of motivation cited were: increasing problems with alcohol, mental health problems, and physical health problems. There was greater variability among internal sources of motivation than among external sources of motivation. Participants' partners but not the male participants themselves, experienced an increase in marital satisfaction from pre- to within-treatment when the participant was motivated to come to treatment by his partner.
TL;DR: Although aggressive driving behavior may be increased by testosterone administration, the drug itself may not be responsible for these effects and a semi-controlled research environment may be necessary.
Abstract: The effect of physiologic (100 mg/wk) and supraphysiologic (250 and 500 mg/wk) doses of testosterone cypionate (TC) on automobile driving were studied using the Iowa Driver Simulator. Six normal subject volunteers were studied off TC and on TC once steady-state concentrations were achieved after at least three weeks of dosing. Despite the administration of supraphysiologic testosterone doses, an increase in aggressive driving behavior was not detected. Likewise, corresponding psychometric testing using the Buss-Durkee Hostility Inventory to assess aggression was unable to detect any change in aggression in the test subjects. Although aggressive driving behavior may be increased by testosterone administration, the drug itself may not be responsible for these effects. Supraphysiologic doses greater than 500 mg/wk and a semi-controlled research environment may be necessary to produce this effect since case reports of AAS abuse causing altered driving behavior may be multifactorial in nature.
TL;DR: The feasibility of teaching beginning therapists how to apply Network Therapy, a cognitive-behavioral approach to achieving abstinence and preventing relapse that augments individual therapy with support from family and friends, is studied.
Abstract: Mental health practitioners in the office setting are often seen as deficient in addiction treatment skills. Relevant training in often quite limited, and trainees are generally not introduced in an effective office-based modality. We studied the feasibility of teaching beginning therapists how to apply Network Therapy, a cognitive-behavioral approach to achieving abstinence and preventing relapse that augments individual therapy with support from family and friends. The therapists were 19 psychiatric residents without experience in substance abuse treatment or outpatient therapy, and the patients were 24 cocaine-dependent patients who received a 24-week course of Network treatment. The patients remained in treatment for an average of 15.4 weeks. Seventy-nine percent of their observed weekly urine toxicologies were negative for cocaine, and 42% of patients produced clean urines in the 3 weeks immediately before termination. The overall outcome compares favorably with that reported in studies on cocaine treatment where experienced therapists were employed. Our results suggest that naive mental health trainees can be taught to apply Network Therapy for effective substance abuse management. This is particularly relevant to technology transfer for general mental health trainees, who are often thought to be perceived to be refractory to learning about the outpatient management of addiction.
TL;DR: Characteristics of injecting drug users (IDUs) who want treatment and the features that differentiate them from IDUs who do not want treatment are examined and implications of these findings are discussed.
Abstract: This study examined characteristics of injecting drug users (IDUs) who want treatment and the features that differentiate them from IDUs who do not want treatment. Data were collected as part of a community-based HIV prevention project in San Antonio, Texas. Interviews were administered to 1,100 IDUs between February 1993 and May 1995. Interview topics included sociodemographics, drug use history, current drug use, treatment history, injection-related HIV risk behavior, sexual behavior, and previous contact related to HIV prevention. Multiple logistic regression analysis identified four factors independently associated with wanting treatment in the multivariate model. These were: (1) 30 or more injections per month; (2) being eligible for methadone maintenance; (3) 2 or more previous treatment admissions; and (4) being recruited after the first year of the project. Implications of these findings are discussed.