Science & Practice Perspectives 

About: Science & Practice Perspectives is an academic journal. The journal publishes majorly in the area(s): Substance abuse & Methadone. Over the lifetime, 46 publications have been published receiving 1328 citations.

The Neurobiology of Opioid Dependence: Implications for Treatment

Abstract: Opioid tolerance, dependence, and addiction are all manifestations of brain changes resulting from chronic opioid abuse. The opioid abuser’s struggle for recovery is in great part a struggle to overcome the effects of these changes. Medications such as methadone, LAAM, buprenorphine, and naltrexone act on the same brain structures and processes as addictive opioids, but with protective or normalizing effects. Despite the effectiveness of medications, they must be used in conjunction with appropriate psychosocial treatments.

Imaging the Addicted Human Brain

Abstract: Modern imaging techniques enable researchers to observe drug actions and consequences as they occur and persist in the brains of abusing and addicted individuals. This article presents the five most commonly used techniques, explains how each produces images, and describes how researchers interpret them. The authors give examples of key findings illustrating how each technique has extended and deepened our knowledge of the neurobiological bases of drug abuse and addiction, and they address potential clinical and therapeutic applications.

Mood disorders and substance use disorder: a complex comorbidity.

Abstract: Mood disorders, including depression and bipolar disorders, are the most common psychiatric comorbidities among patients with substance use disorders. Treating patients' co-occurring mood disorders may reduce their substance craving and taking and enhance their overall outcomes. A methodical, staged screening and assessment can ease the diagnostic challenge of distinguishing symptoms of affective disorders from manifestations of substance intoxication and withdrawal. Treatment should maximize the use of psychotherapeutic interventions and give first consideration to medications proven effective in the context of co-occurring substance abuse. Expanded communication and collaboration between substance abuse and mental health providers is crucial to improving outcomes for patients with these complex, difficult co-occurring disorders.

Integrating substance abuse treatment and criminal justice supervision.

Abstract: The drug abuse treatment and criminal justice systems in this country deal with many of the same individuals. Approximately two-thirds of clients in long-term residential drug abuse treatment, one-half of clients in outpatient drug abuse treatment, and one-quarter of clients in methadone maintenance treatment are currently awaiting a criminal trial or sentencing, have been sentenced to community supervision on probation, or were conditionally released from prison on parole (Craddock et al., 1997). Conversely, 60 to 80 percent of prison and jail inmates, parolees, probationers, and arrestees were under the influence of drugs or alcohol during the commission of their offense, committed the offense to support a drug addiction, were charged with a drug- or alcohol-related crime, or are regular substance users (Belenko and Peugh, 1998). The co-occurrence of drug abuse and crime is not simply an artifact of criminalizing drug possession. Drug use significantly increases the likelihood that an individual will engage in serious criminal conduct. More than 50 percent of violent crimes, including domestic violence, 60 to 80 percent of child abuse and neglect cases, 50 to 70 percent of theft and property crimes, and 75 percent of drug dealing or manufacturing offenses involve drug use on the part of the perpetrator—and sometimes the victim as well (e.g., Belenko and Peugh, 1998; National Institute of Justice, 1999). Sustained abstinence from narcotics is associated with a 40- to 75-percent reduction in crime (e.g., Harrell and Roman, 2001). In dealing with drug abusers who are criminal justice offenders, many clinicians and service providers support a public health perspective, contending that clients are best served through a focus on treatment, with only minimal involvement of the criminal justice system. They sometimes find themselves at odds with public safety proponents who say that criminal offenders require constant supervision to succeed. Both views are valid, but neither is adequate in itself. Research has shown that neither the pure public safety nor an exclusively public health approach to the problem works fully; instead, it supports an integrated approach that has very specific implications for best practices (see Marlowe, 2002, for review). This article briefly reviews results obtained from one-dimensional public safety and public health strategies and presents promising findings from integrated public health-public safety programs. Finally, the implications for best treatment practices and client-program matching are discussed.

Assessing organizational functioning as a step toward innovation.

Abstract: Innovate and adapt are watchwords for substance abuse treatment programs in today’s environment of legislative mandates, effective new interventions, and competition. Organizations are having to evolve—ready or not—and those that are ready have superior chances for success and survival. The Texas Christian University Organizational Readiness for Change (ORC) survey is a free instrument, with supporting materials, that substance abuse treatment programs use to assess organizational traits that can facilitate or hinder efforts at transition. This article presents organizational change as a three-stage process of adopting, implementing, and routinizing new procedures; describes the use of the ORC; and outlines a step-by-step procedure for clearing away potential obstacles before setting forth on the road to improved practices and outcomes.