摘要:

The frequent co-occurrence of mental and substance use disorders (“dual diagnosis”) has created a role for addiction-trained psychiatric consultants in drug and alcohol treatment programs. The complex treatment needs of the dually diagnosed require that the consultant psychiatrist have knowledge about the existing treatment models of chemical dependency, the recovery process, and the complex relationship between substance abuse and psychopathology. This paper reviews the existing clinical models for understanding and treating chemical dependency and then proposes an approach to consultation practice that employs a developmentally-based clinical model. The consultation work of three academic addiction psychiatrists who utilize a developmental approach is described. The demographic and diagnostic characteristics of their consultation cases from three substance abuse inpatient rehabilitation programs for a 1-year period are summarized. Five major tasks for addiction psychiatry consultants are identified and discussed: diagnostic evaluation, identification of recovery barriers, identification of relapse triggers, recovery-oriented brief psychotherapy, and pharmacotherapy.

ISSN:0095-2990    

DOI:10.3109/00952999409106015

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor

摘要:

This study investigated high school students' marijuana usage patterns in relation to their harmfulness ratings of 15 licit and illicit drugs, perceived negative consequences from using marijuana, and types of defense mechanisms employed. Subjects were classified into one of five pattern-of-use groups based on marijuana usage: principled nonusers, nonusers, light users, moderate users, and heavy users. Principled nonusers (individuals who have never used marijuana and would not do so if it was legalized) rated marijuana, hashish, cocaine, and alcohol as significantly more harmful than heavy users. A cluster analysis of the drugs' harmfulness ratings best fit a three cluster solution and were named medicinal drugs, recreational drugs, and hard drugs. In general, principled nonusers rated negative consequences from using marijuana as significantly more likely to occur than other groups. Principled nonusers and heavy users utilized reversal from the Defense Mechanism Inventory, which includes repression and denial, significantly more than nonusers, indicating some trait common to the two extreme pattern-of-use groups.

ISSN:0095-2990    

DOI:10.3109/00952999409106016

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor

摘要:

Our objective was to assess the effects of methadone use on immune parameters. A convenience sample of men and women drug injectors who knew their HIV serostatus were enrolled in a longitudinal observational study of HIV illness. During analysis of baseline data, differences were noted in immune parameters among Methadone users. Study participants were recruited in Manhattan, New York, from a methadone maintenance clinic, an infectious disease clinic of an inner city hospital, and a drug-free community center. The participants were 220 men and women, current or former drug injectors, approximately half of them HIV-antibody positive and the rest HJV-antibody negative. Candidates with opportunistic infections and secondary neoplasms were excluded. Methadone users were compared to nonmethadone users for absolute and percentage counts of CD4, CD8, and activated T lymphocytes; CD4/CD8 ratio; an HIV symptom check list; and medical staging. The results discussed in this paper were formulated after data collection was complete. Our data indicate that methadone treatment, while not significantly affecting absolute CD4 lymphocyte count, is associated with a lower CD4 percentage and CD4/CD8 cell ratio, and with a higher CD8 absolute count and percentage. These differences are present regardless of HIV serostatus. Our findings should be interpreted with caution since we did not set out to investigate the effects of methadone on the immune system. Nevertheless, if it is corroborated that methadone has a detrimental effect on the immune system, finding allernatives to methadone-maintenance treatment for drug injectors will be a necessity.

ISSN:0095-2990    

DOI:10.3109/00952999409106017

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor

摘要:

Previous studies of residential and outpatient drug treatment programs have found that retention is higher in residential than in outpatient programs. This study attempts to verify previous findings by conducting an experiment that controls for ecological, self-selection, and program content biases. The Houston Recovery Campus is a research-focused, multiple-provider drug treatment facility for the indigent of Harris County, Texas. During the study period, 646 applicants were randomly assigned to two comparable 28-day programs. The first program was a residential program; the second was an outpatient day treatment program. Twenty-eight day retention rates were significantly higher for the residential program (76%) compared to the day treatment program (64%).

ISSN:0095-2990    

DOI:10.3109/00952999409106018

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor

摘要:

The purpose of this investigation was to determine if parental substance abuse places children at a higher risk regarding their own substance abuse, illegal activities, and psychological functioning. An intake assessment was conducted with 299 crack smokers currently undergoing treatment. It revealed that clients with a parental history of substance abuse were at over twice the risk for antisocial personality disorders, had been arrested significantly more times as an adult, were more likely to report illicit drug use in the past year, and had received prior treatment more often than clients without a parental history of substance abuse. Surprisingly, no relationship was observed between parental history of substance abuse and preadult behaviors including age-of-onset of drug use, childhood conduct disorders, age at first antisocial behavior, or number of arrests before age 18. Future prevention and treatment efforts with similar populations should recognize the strong influence of the family in the development of substance abuse.

ISSN:0095-2990    

DOI:10.3109/00952999409106019

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor

摘要:

Irregular discharges, previously studied on psychiatric or substance abuse treatment units, are a particular problem for dual diagnosis units. We examined demographic and clinical variables for their association with irregular discharge from an acute dual diagnosis inpatient unit, retrospectively reviewing 316 consecutive admissions. One hundred and nineteen patients (37.7%) were irregularly discharged (61 AMA, 31 administrative, 27 elopements), staying an average of 18.8 days compared with 51.4 days for those regularly discharged(p<. 001). Younger age(p=. 007) and discharge diagnosis of antisocial personality disorder(p<. 001) were associated with irregular discharge; the attending psychiatrist was also significant(p=. 016). Demographic variables (sex, ethnicity, marital status, religion, employment, education, living circumstances), Axis I diagnosis, and type and number of substances abused were not predictive of discharge type. Patients irregularly discharged within the first week (40% of irregular discharges) were significantly less likely to have known legal involvement (p =. 006). No significant temporal clustering of irregular discharges was found on a daily, weekly, or monthly basis, nor was a seasonal pattern detected. These findings are generally consistent with several pre-DSM-III studies on nondual diagnosis units, but more specifically highlight the diagnosis of antisocial personality. Regarding program completion, they suggest that risk factors for irregular discharge (substance abuse, antisocial personality, characteristics of the doctor-patient relationship, problems of younger patients) have not been adequately addressed simply by creating dual diagnosis units. Further programming study appears warranted to address the problem of patient retention on dual diagnosis units.

ISSN:0095-2990    

DOI:10.3109/00952999409106020

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor

摘要:

The authors examine a model which specifies the relationships among criminality and the use of alcohol and other drugs. A pattern is hypothesized: The initiation of alcohol/drug use tends to progress from legal to illicit drugs; the early initiation of drugs increases the current use of drugs; and criminality is affected by the initiation/use patterns. Analyses based on data collected from individuals in jails, drinking driver programs, alcoholism treatment centers, and on probation indicate that the early onset of legal drug use induces the onset of illicit drug use. Criminality is affected by the current use of alcohol and cocaine. Comparison and contrast of findings from the four groups are provided.

ISSN:0095-2990    

DOI:10.3109/00952999409106021

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor

ISSN:0095-2990    

DOI:10.3109/00952999409106022

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor