摘要:

Patients with substance dependence and psychiatric symptoms often present a diagnostic conundrum because each of these problems may mutually and reciprocally complicate the other. This may challenge the ability to identify dual-diagnosis patients who have both a substance abuse disorder and a definitive symptom-based psychiatric disorder. The main purpose of this explorative study was to identify variables suggestive of dual diagnosis in the population of substance-dependent patients with psychiatric symptoms. A secondary purpose was to examine the subgroups in this population for their distinctiveness from one another. Based upon clinical experience and the literature, seven independent variables were hypothesized as suggestive of dual diagnosis. Seventy-nine patients with substance dependence and psychiatric symptoms of depression, anxiety, and/or psychosis were assessed for symptom and disorder status generating three subgroups: I) 20 patients with psychiatric symptoms not meeting thresholds for clinical significance; II) 36 patients exhibiting a psychiatric disorder (dual diagnosis); and III) 23 patients with psychiatric symptoms meeting thresholds for clinical significance but not for a disorder. Odds ratios were calculated to examine the risk for dual diagnosis using the seven independent variables. A persistent increased risk for dual diagnosis was observed in patients who were positive for the seven variables. The seven variables were combined into an overall measure of patients' risk for dual diagnosis. Mean scores were significantly different for the three groups F(2,76) = 8.4,p<. 001. This study indicates variables that may be suggestive of dual diagnosis and finds subgroup distinctiveness in this sample. Both of these findings have treatment implications.

ISSN:0095-2990    

DOI:10.3109/00952999409109180

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor

摘要:

Inner-city male adolescents in jail in New York City (N= 427) were interviewed to examine correlates of cocaine or crack use. Twenty-three percent had used cocaine or crack in the month before arrest and 32% reported lifetime use. Substantial rates of robbery, murder, other violent crime, weapons possession, and drug dealing were found. However, type of crime, including violent crime, was not related either to cocaine/crack use or to drug dealing. Current cocaine/crack users were more likely to use alcohol, marijuana, and intranasal heroin; to have multiple previous arrests; to be out of school; to be psychologically distressed; to have been sexually molested as a child; to have substance abusing parents; and to have cocaine/crack-using friends. They were also more likely to have frequent sex with girls, to be gay or bisexual, and to engage in anal intercourse. The findings should be considered in developing more effective drug abuse prevention and treatment interventions, and HIV prevention education, for incarcerated at-risk adolescents.

ISSN:0095-2990    

DOI:10.3109/00952999409109181

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor

摘要:

Crack cocaine dependence rapidly leads to physical deterioration and severe social consequences. There is no widely accepted standard of treatment. As such, it is important to attract broad samples of patients into treatment research to improve efficacy and to establish generalizability. Better understanding of what attracts different subgroups of cocaine users into treatment, particularly research-based treatment, is needed. This article assesses the efficacy of six different recruitment strategies for attracting different populations of male veterans into treatment for crack cocaine dependence. New directions are outlined for the examination of recruitment strategies.

ISSN:0095-2990    

DOI:10.3109/00952999409109182

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor

摘要:

In a 6-month randomized trial comparing 125 opiate-dependent patients who were assigned to four treatment groups (2 or 6 mg of buprenorphine and 35 or 65 mg of methadone), we examined the effects of cocaine use on opiate withdrawal symptoms measured on a 25-item scale on which the scores range from 0 to 75. For the methadone-maintained patients receiving the relatively low dose (35 mg), weekly withdrawal symptoms were highest when the urine toxicology for that week indicated no cocaine use. Similar associations were found for buprenorphine. Thus, when using cocaine at a low maintenance opiate dose, persistent opiate withdrawal symptoms were reduced, which is consistent with previous naloxone-precipitated withdrawal studies. Interestingly, with a higher dose of buprenorphine (6 mg), cocaine may have increased opiate withdrawal symptoms, suggesting a possible mechanism for the reduction of illicit cocaine abuse also recently observed in another study in patients treated with high dose (120 mg) methadone maintenance. This has led to a two-component model for the relationship between cocaine and opiate withdrawal-like symptoms at high versus low opiate maintenance dose. This two-component model also reconciles the contradictory findings of prior studies.

ISSN:0095-2990    

DOI:10.3109/00952999409109183

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor

摘要:

Adolescence is a time of significant developmental transformation during which the teenager may be susceptible to experimental behaviors such as illicit drug use. This risk-taking proclivity may arise because the adolescent is just beginning to consolidate the skills of formal operations thought, including abilities to predict behavioral outcomes, weigh options, select alternatives, and adopt the perspective of others. Lacking these skills, teenagers may have difficulty adjusting to pubertal status and family conflict. One technique for overcoming this cognitive deficit is previewing, which focuses the teenager on imminent outcomes. A case history concerning a teenager abusing marijuana illustrates how previewing may help overcome maladaptive patterns.

ISSN:0095-2990    

DOI:10.3109/00952999409109184

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor

摘要:

Many people with alcohol dependence use other drugs. However, not much is known about the relationship between their past drug use (not necessarily dependence) and their prognosis following treatment. The goal of this study is first to determine the drug use rates among primary alcoholic men and then to evaluate the possible relationship between past drug use and future alcohol or drug use relapse. As a result, 630 primary alcoholic veterans were recruited from a 28-day inpatient Alcohol and Drug Treatment Program at the San Diego VA Medical Center. Among them, almost two-thirds also had a history of drug use. Subjects were divided into the following four groups which were determined by their lifetime drug use histories: Group I (N= 226) consisted of drug abstainers, Group 2 (N= 142) was made up of alcoholics who had used only marijuana, Group 3 (N= 210) contained stimulant users who had never used opiates, and Group 4 (N= 52) included all opiate users. Comparisons of the four groups at a 3-month follow-up revealed that alcoholic men who had a history of stimulant or opiate use (Groups 3 and 4) were more likely to have had a drug use relapse. However, the four groups had similar alcohol relapse rates.

ISSN:0095-2990    

DOI:10.3109/00952999409109185

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor

摘要:

Based upon clinical considerations, scales were developed measuring client perceptions across four interrelated domains: circumstances (external pressures), motivation (intrinsic pressures), readiness, and suitability (CMRS) for residential TC treatment. This paper, the first in a series, reports findings on the reliability of the CMRS and its validity as a predictor of retention in TC treatment in three cohorts of consecutive admissions to a long-term residential TC. The main findings show that: (a) discriminant and factor analyses confirm the face validity of the original four rationale scales; (b) scores distribute into four groups, with most clients in the moderately low to moderately high range; (c) two cross-validation studies confirm the internal consistency of the scales, and a linear relationship between the separate and total CMRS scores and short-term retention in all three cohorts and long-term retention in two cohorts. The present psychometric study provides impressive findings on the reliability and validity of the CMRS scales as predictors of retention in long-term TCs. Although still considered experimental, awaiting replicational studies and firm conclusions concerning generalizability, the CMRS holds considerable promise for research, theory, and practice.

ISSN:0095-2990    

DOI:10.3109/00952999409109186

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor

摘要:

The value of using a visual representation strategy, called node-linking mapping, was evaluated in individual and group drug abuse counseling settings. Methadone maintenance clients were randomly assigned to counselors trained to use mapping techniques (n= 57), and those who used standard counseling (n= 51). Clients in the mapping counseling group had more favorable perceptions of their own therapeutic engagement and progress as indicated by ratings of cognitive-behavioral and motivational attributes than did those in standard counseling. Overall, individual sessions were viewed by clients as being more valuable man group counseling, but the use of mapping increased the helpfulness attributed to group counseling to near the same level as individual counseling.

ISSN:0095-2990    

DOI:10.3109/00952999409109187

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor

摘要:

We examined hospital utilization and use of community facilities for the treatment of alcohol problems in Ontario using Statistics Canada, Hospital Medical Records Institute records, and other administrative records. Between 1974 and 1986 there was a large drop in utilization of hospital services for treatment of alcohol problems. Rates of alcohol inpatient cases in general hospitals dropped by 47% and in mental hospitals by 33%. At me same time, there was an increase in overall availability of hospital beds and bed-days of care for all medical conditions, and no change in the total number of hospital discharges (1.3 million) and occupancy rates (80-85%). Also at the same time, the number of community-based programs for the treatment of alcohol problems increased, as did the number of persons or cases treated by them. This was associated with a drop of inpatient cases treated for alcohol problems in 38 out of 48 counties in Ontario (P>. 0005). Multiple regression techniques were used to take into account the effect of the slight decline in overall alcohol consumption in this period. We found that after controlling for changes in alcohol consumption, the addition of one community-based alcohol treatment program was associated with a reduction in the number of cases treated on a hospital inpatient basis for alcohol-related problems, with a short-run drop of 27.1 hospital cases within 1 year of a community facility's availability and a long-run reduction of 52.2 cases. (P>. 005)

ISSN:0095-2990    

DOI:10.3109/00952999409109188

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor

摘要:

This article presents the results on the patterns of alcohol consumption among illicit and licit drug users in a Greek nationwide sample of general population with 4,290 respondents aged 12 to 64. The type of survey was cross sectional and the respondents were interviewed in their homes with a multidimensional structured questionnaire. The illicit drug users of all age groups reported a higher frequency of alcohol consumption in their lifetime, past year, month, and week prior to interview than the unprescribed licit drug us-ers and the nonusers. The majority of illicit drug users of all ages reported as their reason for drinking“to feel better or to get high.”Illicit drug users of all age groups had a higher frequency of episodes of drunkenness than the other categories. Finally. the higher the frequency (23 times) of illicit drug use, the more excessive drinking reported during the past year and month. Forty percent of this category of illicit drug users reported that they had two or more serious alcohol-related problems.

ISSN:0095-2990    

DOI:10.3109/00952999409109189

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor