摘要:

Despite its common use, the term“craving”is controversial. Moreover, its measurement can be problematic, since craving is purely subjective and is highly influenced by setting and drug availability. Thus, one might expect patients in protective settings such as hospitals to experience little craving, despite potentially being at high risk to relapse upon discharge. In this study of 73 patients hospitalized for cocaine dependence, we developed a series of five questions to measure different aspects of cocaine craving: 1) current intensity, 2) intensity during the previous 24 hours, 3) frequency, 4) responsiveness to drug-related conditioned stimuli, and S) imagined likelihood of use if in a setting with access to drugs. We hypothesized that some hospitalized patients with low craving levels might believe their risk of relapse to be high in another setting. We then examined the relationship between inpatient craving levels and 3-month treatment outcome. Results revealed a high level of internal consistency, with Cronbach's alpha scores of. 82 to. 94 on daily measures; factor analysis revealed unidimensionality; and each of the five items showed significant decreases in craving over time. The question regarding likelihood of use in another setting consistently scored higher than other questions on current craving (p&.001). Predictive validity was assessed by examining 3-month outcome. Among the 37 patients who participated in a follow-up study, there were no statistically significant relationships between 3-month cocaine use outcome and any item on the craving scale. Neither inpatient craving levels nor predictions regarding future use correlated with actual 3-month outcome.

ISSN:0095-2990    

DOI:10.3109/00952999509002698

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

This study examines outcome of treatment for psychoactive substance dependence in a clinic which made psychiatric care readily available. Veterans entering outpatient treatment for substance dependence (n= 222) received psychiatric evaluation for additional Axis I disorders using DSM-III-R criteria. Patients provided urine toxicology specimens at least weekly. Outcome (urinalysis results and treatment retention) was compared for patients with dual diagnosis (n= 103, 46.4%) and with substance only diagnosis (n= 119, 53.6%). Psychotropic medications were prescribed for 80.4% of the dual diagnosis subjects. In the first 6 months of treatment, dual diagnosis subjects compared to substance only diagnosis subjects gave a significantly greater percentage of urines positive for cocaine and opioids. In the second 6 months, dual diagnosis subjects who remained (n= 72, 70.0%) significantly reduced from the first 6 months their percentage of cocaine and opioid positives and did not differ in percent positives from substance only diagnosis subjects who continued past 6 months (n= 70, 58.8%). Treatment retention of dual diagnosis subjects (median months = 14.3) exceeded that of substance only diagnosis subjects (8.9; Lee-Desu Statistic = 9.02,p<. 003). Dual diagnosis patients may initially perform more poorly than substance only diagnosis patients in substance dependence treatment. However, in the presence of psychiatric care, they eventually exhibit comparable success.

ISSN:0095-2990    

DOI:10.3109/00952999509002699

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

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

ISSN:0095-2990    

DOI:10.3109/00952999509002700

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

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

ISSN:0095-2990    

DOI:10.3109/00952999509002701

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

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

ISSN:0095-2990    

DOI:10.3109/00952999509002702

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

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

ISSN:0095-2990    

DOI:10.3109/00952999509002703

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

One hundred twenty-four male veterans were enrolled in the Birmingham VAMC Outpatient Substance Abuse Clinic (OSAC) aftercare program following inpatient treatment for alcohol, cocaine, or mixed alcohol-cocaine abuse/dependence. Forty-two of the patients were concurrently admitted to a nearby halfway house (HH) while the remaining 82 patients made community-based (CB) living arrangements. Chi-square analysis showed the two groups were matched,p>. 05, in regard to age, race, marital status, presenting problem, and referral source. The CB group experienced significantly,p<. 05, higher early dropout (40 vs 0%) from aftercare. Of the others engaging in treatment, the HH patients stayed in OSAC aftercare 60 days longer and had significantly,p<. 01, more clinic visits. A higher proportion,p. 05, the frequency of HH patients receiving administrative discharge status of Treatment Complete was twice (28.2%) that of CB patients (15.1%). Itis concluded that concurrent halfway house placement can aid in aftercare retention and completion.

ISSN:0095-2990    

DOI:10.3109/00952999509002704

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

Objective: The objective of this research was to ascertain whether geographical accessibility (in conjunction with other patient characteristics) reduced the probability of participating in alcoholism aftercare treatment.Methods: A sample of 4,621 United States male veterans discharged with an outpatient appointment from one of 33 Department of Veterans Affairs inpatient Alcohol Dependency Treatment Programs was identified. The outpatient records of each patient were obtained to determine whether aftercare services were utilized following discharge. Binary choice analysis was used to model the decision to enter aftercare treatment as a function of travel distance, age, marital status, ethnicity, severity of illness, and urbanization.Results: Travel barriers significantly reduced aftercare participation, especially for elderly and rural veterans. Both younger and older veterans were less likely to keep their aftercare appointment than middle-aged veterans. Married patients were more likely to utilize outpatient services than unmarried patients. Ethnic status, severity of illness, and urban size all negatively affected the likelihood of appointment attendance.Conclusions: The results obtained from this analysis can be effectively used to identify which patients are not likely to enter aftercare alcoholism treatment. The discharge plans of patients at risk for appointment noncompliance should be given special attention since aftercare has been shown to improve treatment outcome. Moreover, because alcoholism treatment reduces the utilization of other medical services, promoting continuity of care should help lower the overall costs of providing health care to alcoholic patients.

ISSN:0095-2990    

DOI:10.3109/00952999509002705

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

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

ISSN:0095-2990    

DOI:10.3109/00952999509002706

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

ISSN:0095-2990    

DOI:10.3109/00952999509002707

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor