Showing papers in "American Journal of Drug and Alcohol Abuse in 2003"
TL;DR: To improve the future health and well-being of women and their children, there is a continued need for well-designed studies of substance abuse treatment programming for women.
Abstract: Recent research has shown that women and men differ in substance abuse etiology, disease progression, and access to treatment for substance abuse. Substance abuse treatment specifically designed for women has been proposed as one way to meet women's distinctive needs and reduce barriers to their receiving and remaining in treatment. However, relatively few substance abuse treatment programs offer specialized services for women, and effectiveness has not been fully evaluated. This article reviews the literature on the extent and effectiveness of substance abuse treatment programming for women and provides an overview of what is known about the components of successful treatment programs for women. Thirty-eight studies of the effect on treatment outcomes of substance abuse treatment programming for women were reviewed. Seven were randomized, controlled trials, and 31 were nonrandomized studies. In our review, six components of substance abuse treatment programming for women were examined: child care, prenatal care, women-only programs, supplemental services and workshops that address women-focused topics, mental health programming, and comprehensive programming. The studies found positive associations between these six components and treatment completion, length of stay, decreased use of substances, reduced mental health symptoms, improved birth outcomes, employment, self-reported health status, and HIV risk reduction. These findings suggest that to improve the future health and well-being of women and their children, there is a continued need for well-designed studies of substance abuse treatment programming for women.
428 citations
TL;DR: The results of this study suggest that the physical functioning of adult substance abusers is similar to the levels for patients diagnosed with other serious chronic diseases, but that mental functioning is much lower.
Abstract: Purpose. Quality of life (QOL) has become an important endpoint in clinical trials and studies of medical interventions for many chronic diseases, but has not been widely studied in the substance a...
177 citations
TL;DR: The results showed that before pregnancy, women who were physically assaulted by their partners were somewhat more likely to drink alcohol and use illicit drugs compared with women who did not experience such violence, but after the women became pregnant, the links between women's experiences of intimate partner violence and their use of substances became stronger.
Abstract: Although some research has found links between women's experiences of intimate partner violence and their use of substances, little research has examined how this potential relationship changes whe...
130 citations
TL;DR: Dual diagnosis inpatients with PDs appear to improve as much as patients without PDs during their inpatient hospitalizations; however, they appear to be less likely to be compliant with attending their initial follow-up appointment.
Abstract: The presence of a personality disorder (PD) has been associated with certain types of poor treatment outcomes in patients with substance use disorders (SUDs). The purpose of this study was to deter...
80 citations
TL;DR: The results did not show strong associations between Cloninger's Harm Avoidance and Reward Dependence dimensions and preferred substance or motivations for use, but it was found that individuals low in novelty seeking tended to prefer alcohol and marijuana, whereas those high in NS endorsed a wider range of preferred substances.
Abstract: This study examined the utility of Cloninger's tridimensional personality theory (1986, 1987a) in predicting preferred substance of abuse and self-reported motivations for use among a sample of 200 adolescent substance abusers and 200 matched community control adolescents. Two primary hypotheses were tested: (1) Cloninger's type II profile is more strongly associated with stimulant use, and his type I profile is more strongly associated with substances having sedative-hypnotic effects; and 2) type II individuals will report motivations for use that focus primarily on obtaining positive rewards, whereas type I individuals will report motivations primarily concerning negative reinforcement or the avoidance of problems and negative life experiences. Our results did not show strong associations between Cloninger's Harm Avoidance and Reward Dependence dimensions and preferred substance or motivations for use. However, in partial support of the hypotheses examined here, we did find that individuals low in novelty seeking (NS) tended to prefer alcohol and marijuana, whereas those high in NS endorsed a wider range of preferred substances. High NS was associated with significantly greater stimulant use and motivations focused on obtaining positive rewards, whereas low NS was associated with greater sedative use and motivations related to avoiding negative emotions or negative life experiences.
79 citations
TL;DR: The 12-step intervention was more effective in decreasing alcohol use and increasing social interactions, however, a worsening of medical problems, health status, employment status, and psychiatric hospitalization were associated with the 12- step intervention.
Abstract: The purpose of this study was to compare the effectiveness of 12-step and cognitive-behavioral (Self-Management and Recovery Training [SMART]) approaches for persons with a dual diagnosis of serious mental illness and substance use disorder in an intensive outpatient/partial hospitalization setting. Participants (n = 112) were alternately assigned to the two treatment conditions, with 50 participants completing the 6-month treatment program. Assessments occurred at baseline, 3 months, and 6 months during treatment, and at 3- and 12-month follow-ups. Analyses were conducted on participants who had completed 3 months of treatment (n = 70). The 12-step intervention was more effective in decreasing alcohol use and increasing social interactions. However, a worsening of medical problems, health status, employment status, and psychiatric hospitalization were associated with the 12-step intervention. SMART was more effective in improving health and employment status, but marijuana use was greater for SMART participants. Improvements in alcohol use and life satisfaction occurred in both approaches. Covariates associated with treatment outcome were identified, with greater attendance being positively related to outcome. Involvement with the criminal justice system was positively related to treatment completion but negatively associated with medical problems. Less alcohol use, fewer medical problems, and better financial well-being at baseline were associated with better attendance.
79 citations
TL;DR: This study examined the differential prediction of alcohol use and problems by biopsychological and social‐environmental variables to indicate that impulsivity and affect lability were related directly with use‐related problems, while social norms and use‐strivings conflict were related indirectly with use-related problems.
Abstract: This study examined the differential prediction of alcohol use and problems by biopsychological (i.e., affective and cognitive variables) and social-environmental (i.e., social norms) variables. Undergraduate students (N = 231) were assessed twice separated by a 30-day interval. Time 1 impulsivity, affect lability, social norms, and perceived conflict between personal strivings and alcohol use were each significant predictors of alcohol use-related problems at Time 2 (T2). Structural equation models indicated that impulsivity and affect lability were related directly with use-related problems, while social norms and use-strivings conflict were related indirectly with use-related problems (mediated by use frequency). Impulsivity moderated the T2 use to use-related problems relationship. Use frequency was associated more strongly with use-related problems among more impulsive participants.
75 citations
TL;DR: Adverse childhood events may contribute to negative adulthood consequences, including consistent substance use and reduced labor force participation, and agencies that are involved in halting the abuse or neglect should participate in more preventive interventions.
Abstract: Objectives: We examined the long‐term effects of adverse childhood events on adulthood substance use, social service utilization, and subsequent labor force participation. Methods: A county‐wide probability sample of 397 homeless adults was interviewed three times in a 15‐month period. By using a path model, literature‐based relationships between adverse childhood events and labor force participation with the mediating effects of adulthood substance use and service use were tested. Results: Adverse childhood events were precursors to adulthood alcohol and drug use. Consistent substance use was negatively associated with long‐term labor force participation and with social service utilization among homeless adults. Adverse events at childhood, however, were positively associated with service use. Conclusions: Adverse childhood events may contribute to negative adulthood consequences, including consistent substance use and reduced labor force participation. Agencies that are involved in halting the abuse or ...
73 citations
TL;DR: The hypothesis that case management improves outcomes better than brief contact for substance-abusing patients with HIV/AIDS in a public general hospital does not support.
Abstract: In a random assignment study, substance-abusing patients with HIV/AIDS in a public general hospital received a brief contact condition or received 12 months of case management delivered by paraprofessionals. Patient outcomes included substance use, HIV transmission risk, physical health, psychological status, and quality of living situation. In both conditions, a significant decrease occurred in a range of problems from Intake to the 6-month interview, followed by no significant pattern of change at 12- and 18-month interviews. On major outcome variables, there were no significant differences between the brief contact and case management conditions. Sixteen percent had died by the 18-month interview. Process data indicated wide variation in the amount of case management received by participants, and the amount of case management was not related to improvement in the outcome measures. The study has limitations yet does not support the hypothesis that case management improves outcomes better than brief contact for this population.
71 citations
TL;DR: The current findings enhance the understanding of the substance-specific profiles of women with PTSD and comorbid substance use disorders and may have important implications for the design of dual-diagnosis interventions.
Abstract: This study examined differences in substance abuse severity, trauma history, posttraumatic stress disorder (PTSD) symptomatology and psychiatric comorbidity among treatment-seeking women (N=74) with PTSD and either comorbid cocaine or alcohol dependence. Women in the cocaine/PTSD group, compared with the alcohol/PTSD group, demonstrated greater occupational impairment (e.g., greater severity on the employment subscale of the Addiction Severity Index, less monthly income, fewer days worked in past month), more legal problems (e.g., greater number of months incarcerated and arrests for prostitution), and greater social impairment (e.g., fewer number of close friends, less likely to be married). Women in the alcohol/PTSD group evidenced higher rates of exposure to serious accidents, other situations involving serious injury, and other extraordinarily stressful life events. Rates of major depression and social phobia were higher among the alcohol/PTSD group than the cocaine/PTSD group. Women in the alcohol/PT...
67 citations
TL;DR: A cross-sectional study of the association between severity of childhood trauma and adult prostitution behaviors was conducted among heterosexual drug addicts in San Antonio, Texas, finding black women reporting severe degrees of emotional abuse, emotional neglect, or physical neglect were more likely to engage in prostitution behavior.
Abstract: A cross-sectional study of the association between severity of childhood trauma and adult prostitution behaviors was conducted among 676 heterosexual drug addicts in San Antonio, Texas. Three hundr...
TL;DR: Understanding that the therapeutic factors inherent in 12-step are not mysterious, but appear to capitalize on well-documented social learning principles, may increase the acceptance of 12- step programs among addiction and mental health professionals.
Abstract: Although research on the effectiveness of 12-step group participation has been increasing, there has been little examination of the processes by which such participation leads to positive outcomes....
TL;DR: Although the MSI‐X version needs psychometric strengthening, it shows potential as a marijuana‐specific screening inventory for use in general mental health and primary care settings and appears useful for screening marijuana use patterns.
Abstract: Objective: Marijuana use prevalence, culturally confusing messages about marijuana risks, assessment dilemmas, and current screening inadequacies justify developing a marijuana specific screening inventory for assessment purposes. This article describes the Marijuana Screening Inventory (MSI‐X) and its preliminary psychometric reliability, factor analyses, and factor structure. Method: The MSI‐X was administered to a community sample of 420 Army reservists participating in substance abuse educational classes. Participants responded anonymously to the 39‐item MSI‐X. SPSS analyses were performed with 408 returned MSI‐Xs from a sample of 49% males and 40% females. Results: Analyses revealed 61% smoked marijuana during their lifetime. Reliability of the MSI‐X was. 89. Exploratory factor analyses of 31 scored items by principal components and varimax rotation supported a nine‐factor structure, explaining 65.8% of the variance, with all items loading ≥ .30. Within the sample, 7.84% scored ≥ 7 suggesting “at ris...
TL;DR: Examination of client and program characteristics associated with program retention among a sample of adolescent probationers referred to residential rehabilitation by the Juvenile Court in Los Angeles suggests that changes in adolescent residential program delivery may serve to increase retention rates, thus improving long-term outcomes.
Abstract: The juvenile justice system relies heavily on residential treatment services for adolescents. Because treatment dropout limits the likely effectiveness of these services, in this study we examine the client and program characteristics associated with program retention among a sample of adolescent probationers referred to residential rehabilitation by the Juvenile Court in Los Angeles. Participants in the present study (n = 291) are a subset of those in the Adolescent Outcomes Project, conducted within RAND's Drug Policy Research Center, to examine the outcomes of youths entering treatment at seven residential treatment programs. Three months after a preadmission interview, youths were asked about their perceptions of counselors at the program, other residents, and their feelings of safety in the program. In addition, they were asked whether they needed and had received various services (e.g., job training, legal advice, family counseling). Results of a multivariate survival analysis revealed that pretreatment characteristics including motivation and substance use severity, as well as treatment program factors including safety, and perceived over- and underprovision of services, contribute significantly to the prediction of retention. Pretreatment environmental risk factors and ratings of program counselor and resident support were marginally significant. These results imply that changes in adolescent residential program delivery may serve to increase retention rates, thus improving long-term outcomes.
TL;DR: In this article, the usefulness of baseline cocaine urine toxicology results and self-reported days of cocaine use in predicting treatment response in cocaine- and opioid-dependent subjects was examined.
Abstract: This study examined the usefulness of baseline cocaine urine toxicology results and self-reported days of cocaine use in predicting treatment response in cocaine- and opioid-dependent subjects. Ninety-nine male and 52 female subjects, maintained on buprenorphine, participated in a 24-week, randomized, double-blind, four-cell trial that evaluated desipramine (150 mg/d) or placebo plus contingency management or a noncontingent voucher control. Out of 151, 102 (67%) subjects had cocaine-positive and 49 (32%) cocaine-negative urines at the beginning of treatment. For the previous 30 days before study participation, 91 (60%) subjects reported using cocaine 15 or less days (low baseline cocaine use) and 60 (40%) subjects reported more than 15 days (high baseline cocaine use). By using the treatment effectiveness score (TES) as the outcome measure, a negative urine for cocaine at baseline predicted a better outcome during a 24-week trial for cocaine and opioid use. There also was a significant interaction between baseline cocaine urine results and desipramine response with the urine cocaine-negative group showing greater desipramine response than placebo for opioid and cocaine use. Self-reported cocaine use at baseline did not show significant predictive power for TES scores during the clinical trial. These results suggest that baseline cocaine urine results should be considered as stratifying variables in clinical trials for cocaine dependence.
TL;DR: Young adult probationers referred to substance abuse treatment show significantly different substance abuse and treatment characteristics as compared with their older adult counterparts, and specialized treatment approaches that focus on enhancing treatment readiness and motivation to change substance use behaviors may be of particular benefit.
Abstract: Although rates of substance abuse continue to rise among young adults ages 18-25, there is little information on the clinical characteristics of young adults referred to treatment, their readiness to change substance use behaviors, and treatment outcomes. These aspects were examined in young (18-25 years old) and older adult (26-45 years old) substance abusers entering treatment at a large, urban, outpatient substance abuse treatment facility. All clients were referred for outpatient treatment by the local Offices of Adult Probation during 1998-1999. The demographic and substance use characteristics, motivation level/readiness to change substance use behaviors, treatment attendance, completion, and "drug-free" status based on patient self-report and urine/breathalyzer data were assessed. Results. Substance-abusing young adult probationers were more likely to be African-American, with a significantly earlier age of onset of primary substance use. They were more likely to have a marijuana use disorder as compared with older adults, who in turn, were more likely to meet criteria for alcohol use disorders. Furthermore, as compared with older adults, young adults had significantly higher scores on precontemplation, and significantly lower scores on contemplation, determination, action, and maintenance subscales of motivation/change readiness. A significantly higher number of young adults did not complete outpatient treatment and were "drug-positive" at discharge, as compared with older adults. Conclusions. Young adult probationers referred to substance abuse treatment show significantly different substance abuse and treatment characteristics as compared with their older adult counterparts. The findings suggest that specialized treatment approaches that focus on enhancing treatment readiness and motivation to change substance use behaviors may be of particular benefit to substance abusing young adults.
TL;DR: It is suggested that the stress‐cocaine link may be generalizable to psychosocial stress and negative affective states defined by POMS, STAI, and HRSD scores.
Abstract: The aim of this study was to explore a potential link between psychosocial stress and cocaine dependence among 36 non-treatment-seeking individuals enrolled in a brain imaging protocol. Stress was assessed using computerized multidimensional instruments, including the Profile of Mood States (POMS) and Speilberger State-Trait Anxiety Inventory (STAI). Additional clinical assessments employed were the Addiction Severity Index and the Hamilton Rating Scale for Depression (HRSD). Based on the median POMS' tension-anxiety scale score the entire sample was divided into two groups, those with high and low levels of stress. The two groups (n = 16 and 20) were similar in terms of age, gender distribution, and severity of addiction. Compared with the low stress group, high-stress individuals displayed significantly longer duration of cocaine use, greater POMS, STAI-state, STAI-Trait, and HRSD scores. Our results replicate those of prior reports implicating stress in the course of cocaine dependence and extend these prior findings by 1) including a new subject population of non-treatment-seekers and 2) by suggesting that the stress-cocaine link may be generalizable to psychosocial stress and negative affective states defined by POMS, STAI, and HRSD scores.
TL;DR: The results suggest that reduction of MA use among younger people is important in promoting their later health and that MA treatment services could be improved by a greater understanding of how early experiences influence later health.
Abstract: Very little research has examined how drug abuse is related to general health status over the long term among both young and middle-aged adults. In this article, we investigate how self-reported health status is related to prolonged methamphetamine (MA) use in a diverse sample of MA users from ages 18 to 52 who have been treated for drug abuse in Los Angeles County. Using retrospective data, we investigate how prolonged MA use within younger and older age groups is related to two self-reported measures of current health status: the presence of a health condition that began after starting illegal drug use, and overall health. We control for the effects of drug use history, social and demographic factors, and other early experiences (e.g., early sexual abuse) that might be obstacles to achieving good health later in life. We find that having a current health condition is predicted by greater age and by more prolonged MA use, especially among younger people. Early sexual abuse predicts both measures of poor ...
TL;DR: It is suggested that patients with MDD may respond better to behavioral treatments such as CM than to desipramine plus buprenorphine, and the ND cocaine‐abusing, opiate‐dependent patients may be more responsive to the anticraving effects of DMI.
Abstract: Depression is common among patients who abuse both opiates and cocaine, and its treatment has had mixed success. This study compares buprenorphine-maintained patients with lifetime major depressive disorder (MDD, N = 53) with those never depressed (ND, N = 96) on cocaine and opiate-free urines during a 12-week outpatient double-blind, placebo-controlled, randomized clinical trial. The 149 subjects were assigned to four groups: 1) desipramine (DMI) + contingency management (CM); 2) DMI + noncontingency management (NCM); 3) placebo + CM; and 4) placebo + NCM. Depression assessments included Hamilton Depression Rating Scale, Center for Epidemiological Studies Depression Inventory, and Structured Clinical Interview for DSM-IV interview for diagnosis of lifetime MDD. Urine toxicologies were performed thrice weekly and the CES-D was performed monthly. The MDD group had a larger proportion of females (45% vs 21%, P = 0.02) and were more likely to be married (13.2% vs 7.3%, P = 0.02) than the ND group. Treatment retention did not vary by depression status. Hierarchical Linear Modeling found that depressive symptoms decreased comparably across the four treatment groups. Although participation in CM improved drug-free urines more for patients with MDD than for the ND group (Z = 2.44, P = 0.01), treatment with DMI was significantly more efficacious for the ND group than for the MDD group (Z = -2.89, P = 0.003). These results suggest that patients with MDD may respond better to behavioral treatments such as CM than to desipramine plus buprenorphine. The ND cocaine-abusing, opiate-dependent patients may be more responsive to the anticraving effects of DMI.
TL;DR: Predicting outcomes for individual patients entering substance abuse treatment has long been a clinical goal in the addictions field and the predictability of short-term outcomes could help clinicians tailor treatment strategies to maximize patient motivation and reduce drinking behavior.
Abstract: Predicting outcomes for individual patients entering substance abuse treatment has long been a clinical goal in the addictions field. Intake data from the Addiction Severity Index and other standardized scales were collected on 248 alcohol dependent/abusing patients entering an urban hospital treatment program. The outcome measure was frequency of drinking days in the past 30 days. Baseline data were used to identify predictors of posttreatment drinking frequency at two follow-up interviews (3 and 12 months postbaseline). Stepwise multiple regressions indicated that a set of baseline predictors accounted for similar and substantial proportions of outcome variance at the two follow-ups. When psychosocial predictors were combined with an index of alcohol use severity (which included drinking frequency), the proportions of variance explained were 31% and 28% at 3 and 12 months, respectively. Two psychosocial predictors were significant at both time periods, and thus most likely to be replicated in future research: a treatment motivation index (a combination of measures of commitment to treatment success and internal motivation to seek treatment) and an index of 12-step (self-help) participation (a combination of measures of frequency of 12-step meeting attendance and perceived helpfulness of 12-step participation). While the predictability of short-term (3 month) outcomes could help clinicians tailor treatment strategies to maximize patient motivation and reduce drinking behavior, the predictability of longer term (12 month) outcomes could help counselors plan aftercare programs, encourage self-help participation, and promote recovery-oriented activities to sustain initial treatment-induced gains.
TL;DR: Comparing changes in the prevalence of heavy problem drinking and drug use among those obtaining emergency room, primary care, and other health care services between 1995 and 2000 suggests drug users may be overrepresented in health service settings, and such settings may provide a window of opportunity for screening and intervention for a reduction in drug‐related problems.
Abstract: Objective: The purpose of this study was to compare changes in the prevalence of heavy problem drinking and drug use among those obtaining emergency room (ER), primary care, and other health care services between 1995 and 2000 in the U.S. general population. Method: Data analyzed are from the Alcohol Research Group's 1995 (n = 4925) and 2000 (n = 7612) National Alcohol Surveys. Data for the 1995 survey was based on face‐to‐face interviews in respondents' homes in the 48 contiguous states, while the 2000 interview was a random‐digit dialing computer‐assisted telephone interview of the household population in all 50 states. Results: Those reporting any health services utilization were less likely to report heavy drinking, two or more alcohol problems, and symptoms of alcohol dependence during the previous year in 2000 compared with 1995, but heavy or problem drinking was not predictive of health services utilization at either time. Controlling for demographic characteristics and health insurance coverage, i...
TL;DR: A “problem severity index” is constructed to categorize individuals based on how acute their problems were at the start of the program, and how the choice of treatment modality affects treatment success.
Abstract: Men and women entering drug treatment programs are known to differ in demographic characteristics and psychosocial behavioral patterns. To be effective, any such program that caters to individuals from both sexes should identify and address these gender-based variations. Studies have also reported clinical differences in the effect of drugs on men and women addicts. Here, we examine whether the treatment is equally effective on men and women, when several demographic covariates are controlled. We construct a “problem severity index” to categorize individuals based on how acute their problems were at the start of the program. We also examine how the choice of treatment modality affects treatment success. Cumulative logit models were used in our analysis. The choice of treatment modality is sex specific, although sex did not appear to be a significant factor for treatment effectiveness when we controlled for other explanatory variables.
TL;DR: In this article, two cases of severe GHB withdrawal syndrome are described that were treated in the inpatient psychiatric unit, among the most severe cases reported.
Abstract: Many psychiatric professionals are unfamiliar with gamma-hydroxybutyrate (GHB), an increasingly popular drug of abuse GHB withdrawal can lead to psychosis and agitation, and patients may present to psychiatric facilities for treatment Withdrawal may progress to delirium, with the potential for severe or even fatal medical complications Therefore, it is imperative for psychiatric professionals to understand how to treat these patients In this article, we describe two cases of severe GHB withdrawal syndrome that were treated in our inpatient psychiatric unit These are among the most severe cases reported Pertinent literature is reviewed and suggestions for treatment are discussed
TL;DR: Although demographic characteristics did not differ between groups, treatment enrollees had greater drug severity and were more likely to identify crack cocaine as their drug of choice and manifested more family and psychiatric problems, emotional distress, and Axis II psychopathology.
Abstract: Despite potentially devastating consequences to both mother and child, many pregnant substance abusers refuse treatment. To understand why, the present study compared women who enrolled in (N = 102) vs. declined (N = 23) day treatment. Participants were primarily African American, unemployed, high school graduates with a mean age of 27 years. Although demographic characteristics did not differ between groups, treatment enrollees had greater drug severity and were more likely to identify crack cocaine as their drug of choice. They also manifested more family and psychiatric problems, emotional distress, and Axis II psychopathology. In addition, treatment enrollees had greater legal severity and higher rates of criminal justice system involvement (46% vs. 13%). The women who declined perinatal addiction services may have perceived less need for intensive treatment due to lower problem severity and less distress. Development of alternative treatment approaches, such as limited perinatal addiction services provided in conjunction with prenatal care, is warranted.
TL;DR: Data suggest that theories related to self‐medication of symptoms and side effects do not appear to account for the difference in rates of substance use found in schizophrenia patients on atypical vs. conventional antipsychotic medications.
Abstract: A large body of research documents the high prevalence and devastating consequences of substance abuse among individuals diagnosed with schizophrenia. One prominent theory of the high rate of comorbidity between these disorders is that substance abuse in schizophrenia is an attempt to self-medicate psychiatric symptoms including negative symptoms and depression as well as side effects including extrapyramidal reactions (EPR). Consistent with this notion, novel antipsychotic medications, which have been shown to reduce negative and depressive symptoms while exhibiting a lower propensity to cause EPR, have been associated with reduced substance abuse in patients with schizophrenia. To further explore the self-medication hypothesis as it relates to the mechanism by which atypical antipsychotics reduce substance abuse, we compared schizophrenia patients with a history of substance abuse medicated with either conventional (n = 35) or atypical (n = 35) antipsychotics. Patients with schizophrenia who did not have a history of substance abuse who were on conventional (n = 23) vs. atypical antipsychotics (n = 29) were also examined. Assessments included the Positive and Negative Symptom Scale, Hamilton Rating Scale for Depression, Simpson-Angus, and Abnormal Involuntary Movement Scale. Compared with conventional medications, atypical antipsychotic drugs were associated with reduced levels of substance use (primarily alcohol). Interestingly, however, in substance-abusing patients there were no significant differences between patients on conventional vs. atypical agents with respect to positive or negative symptoms, depression, or EPR. These data suggest that theories related to self-medication of symptoms and side effects do not appear to account for the difference in rates of substance use found in schizophrenia patients on atypical vs. conventional antipsychotic medications.
TL;DR: There was a high level of self-perceived effectiveness of CAM therapies, and CAM users were likely to use CAM for reasons related to their addiction, and a higher education and lower self-rated health were the two strongest predictors of CAM use.
Abstract: Intravenous drug users often have many health conditions in addition to their drug addiction, yet may be isolated from conventional sources of care. They have never before been examined for their use of complementary and alternative medicine (CAM) therapies. Our purpose was to study the prevalence and predictors of CAM use among persons with a history of intravenous drug use through a cross-sectional survey of intravenous drug users examining their utilization of health services, including CAM therapies. A total of 548 persons with a history of intravenous drug use, recruited from a needle-exchange program and a methadone maintenance clinic, both in Providence, Rhode Island, participated. Overall prevalence of any CAM use in the past 6 months, frequency of use of individual named CAM therapies and domains, and demographic and clinical characteristics associated with CAM users, reasons for CAM use and self-perceived effectiveness of CAM were also measured. Of the 548 participants, 45% reported use of at least one CAM therapy. The top three therapies--religious healing, relaxation techniques, and meditation--were all from the mind-body domain. Having a higher education and lower self-rated health were the two strongest predictors of CAM use, followed by having a regular doctor or clinic, being white and younger. There was a high level of self-perceived effectiveness of CAM therapies (4.1 on a scale of 1-5), and CAM users were likely to use CAM for reasons related to their addiction.
TL;DR: Results suggest that targeting Poor Attenders with contingency management techniques may be a cost‐effective method of improving counseling attendance and early in treatment may be especially important for improving treatment outcomes.
Abstract: Two studies were conducted to investigate the effectiveness of contingency management techniques in promoting punctual counseling attendance among methadone maintenance patients. In Study 1, 50 participants were recruited from an inner‐city methadone maintenance program. Study 1 used an A–B–A design with baseline, intervention, and return‐to‐baseline phases. On‐time attendance was reinforced during the intervention phase with a voucher that was redeemable for a draw out of a box containing 100 tokens with values varying from $0.00 to $100.00. Methadone maintenance patients who exhibited poor attendance during baseline showed a significant positive response during the contingency management intervention phase. Study 2 used the same design as Study 1 except that the 52 participants were randomized into reinforcement groups that received either the variable rate of reinforcement as in Study 1 or a fixed value reinforcer of $3.25. As in Study 1, Poor Attenders significantly improved counseling attendance duri...
TL;DR: Self‐administered questionnaires were mailed to 145 probation officers in nine California counties to identify factors that predicted probation officers' use of coercion to mandate alcohol treatment, and a belief that treatment was effective and one's peers in the department were using coercion frequently was identified.
Abstract: Alcohol problems are widespread among individuals in county criminal justice probation systems. However, it is unclear why only a small fraction of these problem drinkers receive treatment. In this study, self-administered questionnaires were mailed to 145 probation officers in nine California counties to identify factors that predicted probation officers' use of coercion to mandate alcohol treatment. The questionnaire measured characteristics of probation officers, characteristics of their caseloads, and perceptions about their departments. Principle components analysis combined some of the items into six factor-based scales. Multiple regression analyses identified two significant predictors of use of coercion into treatment: a belief that treatment was effective and a belief that one's peers in the department were using coercion frequently. Implications for increasing treatment entry of probationers with drinking problems include educating probation officers about the effectiveness of substance abuse treatment in general and about coerced treatment in particular. Probation departments are encouraged to develop management styles that facilitate shared normative beliefs about assessing and managing alcohol problems among probationers.
TL;DR: Treatment protocols should build upon the positive relationships of parents with their children, and seek to improve those of less-involved parents, given the association of parental involvement with lower levels of addiction severity and psychological distress at baseline.
Abstract: Most studies of parents in drug treatment have focused exclusively on mothers, and few studies have examined the effects of parents' level of involvement with their children on the parents' drug use and psychological functioning, either before or after treatment. This study examined mothers and fathers (n = 331) who were parents of children under the age of 18; participants were sampled from 19 drug treatment programs across four types of treatment modalities in Los Angeles County. A majority of each group (57% of 214 mothers and 51% of 117 fathers) were classified as being highly involved with their children. At the baseline assessment, higher parental involvement was related to lower levels of addiction severity, psychological severity, and symptoms of psychological distress, and to higher levels of self-esteem and perception of parenting skills. In general, fathers had higher levels of alcohol and drug-use severity than did mothers, but fathers who were more involved with their children showed lower levels of addiction severity than fathers who were less involved. Parental involvement at baseline was unrelated to drug use at the 12-month follow-up, although parents who were less involved with their children reported experiencing more stressors. Given the association of parental involvement with lower levels of addiction severity and psychological distress at baseline, treatment protocols should build upon the positive relationships of parents with their children, and seek to improve those of less-involved parents.
TL;DR: Investigation of a skills program developed to address cognitive deficits that may impede substance abuse treatment within the criminal justice system revealed that the CSM was effective in increasing perceived treatment effectiveness (particularly midway through the program).
Abstract: As part of an NIDA-sponsored project, the current study investigated the effectiveness of a skills program we developed called the TCU Cognitive Skills Module (CSM). The program was developed to address cognitive deficits that may impede substance abuse treatment within the criminal justice system. Probationers in a 4-month residential program (followed by 3 months of aftercare) were randomly assigned (by community) to receive standard treatment or treatment enhanced with the CSM program. Peer ratings, individual ratings of the community, and counselor assessments revealed that the CSM was effective in increasing perceived treatment effectiveness (particularly midway through the program). There was also some support for the CSM being especially effective for probationers who enter treatment with lower levels of treatment readiness.