摘要:

This study describes the relationship between the need for psychiatric consultation, illicit drug use, and zidovudine (AZT) adherence in HIV-infected injection drug users (IDUs) in methadone maintenance treatment (MMT). The treatment records of 57 IDUs in MMT who had been prescribed AZT between May and August of 1991 were reviewed. Those who required psychiatric consultation (P+,N= 46, 81%) were compared with those who did not require psychiatric consultation (P-,N= 11, 19%) on adherence to AZT treatment (using the mean corpuscular volume [MCV] as a biological marker), on recent illicit drug use, and on CD4 lymphocyte (T cell) count changes from the beginning to the end of AZT treatment. The P+ subjects were less likely than P- subjects to adhere to AZT treatment: fewer in the P+ group had an MCV outside of the normal range, and P+ subjects had a lower average monthly increase in MCV since the beginning of AZT treatment. Recent illicit drug use and CD4 lymphocyte count changes from the beginning to the end of AZT treatment did not show group differences. Psychiatric morbidity among HIV-infected IDUs in MMT is common, and may contribute to poor adherence to AZT treatment. Psychiatric screening and adherence-enhancing interventions should be targeted to IDUs entering drug treatment programs.

ISSN:0095-2990    

DOI:10.3109/00952999609001674

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

We report on clinical and practical aspects of treatment of opiate addiction with a relatively new approach, rapid opiate detoxification (ROD). The goal is to induce rapid narcotic withdrawal in a controlled environment using narcotic antagonists while suppressing withdrawal symptoms with sedative drugs, thus effecting a dramatic abbreviation of the traditional withdrawal schedule. Twenty-five consecutive heroin-addicted patients presenting for detoxification were treated at a university hospital. There were 14 women and 11 men, with a mean age 32.6 years (range, 24–48). They underwent 29 separate detoxifications over a 4-month period. All but 3 of the detoxifications were effected with ROD. Several different techniques were used over the 4-month period, ranging from intramuscular and oral sedation to intravenous sedation, paralysis, and intubation. Efficacy of detoxification was demonstrated for all patients undergoing ROD; all were given 50 mg of naltrexone PO prior to discharge, and none had withdrawal symptoms. (The three patients treated with abstinence were not so tested.) We derive three conclusions from this early clinical experience: First, ROD appears to be a valuable tool in the treatment of heroin addiction. ROD is an efficient, effective technique that can play an important role in an integrated rehabilitation program. Second, the optimal method of ROD is yet to be determined; a continuum of approaches is available. Third, ROD is probably most suited to designated outpatient centers.

ISSN:0095-2990    

DOI:10.3109/00952999609001675

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

Large numbers of indigent cocaine abusers now present in center-city hospitals. Since many are also diagnosed for severe mental illness, options for their effective treatment are needed. The authors investigated the feasibility of treating these dually diagnosed patients along with the majority of abusers who were not severely impaired in a program that combines peerled treatment with psychiatric management and pharmacotherapy. Although group confrontation techniques were used, schizophrenics (N= 71) and patients with major depressive disorder (N= 50) experienced an outcome as good or better than the less impaired (N= 177) on retention, visit rates, and urinalysis results.

ISSN:0095-2990    

DOI:10.3109/00952999609001676

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

Using AIDS Initial Assessment questionnaire (AIA) data from 353 injection drug users (IDUs) newly admitted to methadone maintenance (MM), three dimensions of injection risk behavior (“sharing with sexual partner,”“sharing with others,”and“new needle use”) were identified. Among IDUs who continued to inject drugs at 1 year, men retained in treatment obtained lower scores on the“sharing with others”scale than men not retained, even when controlling for initial scale scores and injection frequency. Associations between retention in MM and changes in sexual risk were examined using two AIA measures of sexual risk behavior (“number of IDU sexual partners”and“relative frequency of unprotected vaginal intercourse”). Controlling for injection frequency, prior sexual risk, and age, there was no difference in sexual risk for men retained in treatment versus those not retained. Among women, those who stayed in MM for 1 year reported significantly fewer IDU partners.

ISSN:0095-2990    

DOI:10.3109/00952999609001677

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

The treatment of heroin dependence with opioid maintenance has traditionally employed methadone and more recently buprenorphine administered in traditional drug treatment settings. In this pilot study we evaluated buprenorphine maintenance for the treatment of heroin dependence in a program administered by primary-care providers in a primary-care setting. Seven patients were admitted to this nonblinded open-label pilot study and were offered 6 months of primary-care-based buprenorphine maintenance. Buprenorphine was administered in doses of 16 mg on Monday and Wednesday and 32 mg on Friday. Patients were seen weekly by primary-care providers and attended self-help meetings. Of the seven patients admitted to the study, five (71%) completed the 6-month pilot study and two (29%) were removed from the study. Urine toxicology data showed that the majority of urines tested were clear of opioids in four out of five patients who remained in treatment. These results suggest that primary-care-based opioid maintenance using buprenorphine shows promise as a new approach to the treatment of heroin dependence.

ISSN:0095-2990    

DOI:10.3109/00952999609001678

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

Psychotherapy with addicted individuals often involves a shift in therapeutic techniques during the transition from early to later recovery treatment. A conceptual model based in attachment theory can provide a rationale and framework for this shift in the treatment of some addicted persons. Techniques and case material are presented to illustrate how a therapist first“establishes a secure base”and then transitions to“facilitating exploration.”An active, directive, supportive, and educative therapeutic approach that deemphasizes exploratory work in early recovery helps the patient achieve abstinence and develop a sense of security and attachment with the therapist. This sense of therapeutic security combined with ongoing abstinence permits a shift to a more nondirective, expressive therapeutic stance that facilitates the exploratory work of later recovery. Working through these issues in the therapeutic transition provides an excellent opportunity to examine the interpersonal and emotional difficulties of addicted patients. Two cases are presented to illustrate a successful and unsuccessful attempt to establish a secure base and facilitate exploration in substance abuse psychotherapy.

ISSN:0095-2990    

DOI:10.3109/00952999609001679

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

This study compares the views on spirituality of dually diagnosed patients (diagnosed with both substance abuse and general psychiatric disorders) and medical students in order to investigate their respective orientations toward spirituality and their views of the importance of spirituality in the treatment of addiction. We administered a modified version of Feagin's“Orientation to Life and God Scale”to assess religious and spiritual orientation in both the patients and students. A second series of items was developed and administered in order to compare the patients' and students perceptions of the relative importance of a religious and spiritual orientation in substance abuse treatment. A third series of items was also given to compare the nature of religious and health-related services on the inpatient unit that patients and students most wanted to see improved. We found that the medical students responsible for treating substance abuse are significantly less religiously and spiritually oriented than the patients they treat, and that the students do not indicate that spirituality is an important component in the care of these patients. It may be clinically relevant to train medical students in the potential importance of spirituality in addiction treatment so that they can incorporate spirituality into the treatment of addictions.

ISSN:0095-2990    

DOI:10.3109/00952999609001680

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

Alcohol problems frequently go undetected in drug-dependent individuals. In women of childbearing age, the consequences of unrecognized alcohol problems can be severe. Unfortunately, many drug treatment programs lack resources to conduct formal diagnostic interviews with all program admissions. Using the Structured Clinical Interview for DSM-III-R (SCID) as the“gold standard,”the present study compared four clinical tools for assessing alcohol problems in a drug-dependent population. Rates of detecting alcohol problems varied widely (15–76%). The Addiction Severity Index (ASI) and the Family Alcohol and Drug Survey (FADS) yielded the highest sensitivities (96% and 83%, respectively) and specificities (94% and 92%, respectively). Since these instruments require less staff training and background education than the SCID, they offer cost-effective alternatives for efficient screening and assessment of alcohol problems in drug-dependent populations.

ISSN:0095-2990    

DOI:10.3109/00952999609001681

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

Cocaine abusers (N= 42) from an inpatient drug rehabilitation program were interviewed regarding combined use of cocaine with alcohol or cigarettes. Concurrent use of alcohol and cocaine was reported by 37 patients and concurrent use of cigarettes and cocaine by 41 patients. All but two concurrent users reported simultaneous use of alcohol or cigarettes with cocaine. Increased cocaine effect was perceived by 43% of simultaneous alcohol users compared with 15% of simultaneous cigarette users. Patients experienced decreased craving for cocaine and alcohol during treatment, but craving for cigarettes remained essentially unchanged.

ISSN:0095-2990    

DOI:10.3109/00952999609001682

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

On the inpatient substance abuse service of the Philadelphia Veterans Administration Hospital, we found that patients who were admitted to the hospital“unscheduled”had a disproportionately higher incidence of subsequent AMA (against medical advice) discharge, particularly if they were alcoholic. This finding calls into question the cost-effectiveness of hospitalization as an initial treatment strategy for substance abusers who enter treatment impulsively and points out the need for additional study to determine the most cost-effective treatments for addicts whose primary motivation for treatment may be to obtain relief from precipitating stressors.

ISSN:0095-2990    

DOI:10.3109/00952999609001683

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor