ISSN:0279-1072    

DOI:10.1080/02791072.1989.10472152

出版商:Taylor&Francis Group    

年代:1989

数据来源: Taylor

摘要:

Research on the relationship between psychoactive substance dependence and personality disorder has been difficult to interpret. Among the reasons for this difficulty are (1) shifts in conceptualizations of these two classes of disorders, (2) markedly different findings related to age, sex, other demographic variables, and stage of illness, (3) overlapping of diagnositc criteria, and (4) instability of Axis II diagnoses over time in these populations. Personality disorder may be preexisting, but not necessarily predisposing. Nevertheless, Axis II diagnoses can be made in alcohol and other drug dependent patients, and are present in these populations at higher prevalence rates than in the general public. Although amelioration of personality disorder will not in itself necessarily correct substance dependence, Axis II diagnoses are of considerable importance in treatment planning and prognosis. Recent and future research on the genetic typology of alcoholism may shed further light on the complex relationship between genetics, physiology, personality, and addiction.

ISSN:0279-1072    

DOI:10.1080/02791072.1989.10472153

出版商:Taylor&Francis Group    

年代:1989

数据来源: Taylor

摘要:

Patients with alcohol and other substance abuse problems have poorer prognoses if there is a concomitant psychiatric diagnosis. However, becauseseverity of psychiatric problemscontributes more than thespecific psychiatric diagnosisto prognosis, the nature of the interaction between substance abuse treatment outcome and an accompanying psychiatric diagnosis can be questioned. In this article an attempt is made to understand the poor-prognosis-with-psychiatric-diagnosis interaction through a literature review and an analysis of various problem areas that clients bring to substance abuse treatment. Problem areas were measured with a variety of instruments. The results show that groups that vary in severity of psychiatric problems also differ in severity of problems in other areas. As there is no doubt that such dual diagnosis patients pose a considerable treatment challenge, the implications of these findings for theoretical consideration and treatment planning are discussed.

ISSN:0279-1072    

DOI:10.1080/02791072.1989.10472154

出版商:Taylor&Francis Group    

年代:1989

数据来源: Taylor

摘要:

Brief neuropsychological tests were administered to an inpatient substance abuse population to (1) evaluate the status of neurocognitive functioning at admission, (2) assess changes that may occur during the treatment program, and (3) compare various testing devices for clinical application in this setting. Patients entering a 14-day inpatient substance abuse unit were tested within a few days of admission with the Neurobehavioral Cognitive Status Examination (NCSE), the Screening test for the Luria-Nebraska Neuropsychological Battery, and the Trail Making Test. Impaired neurocognitive performance was observed in approximately two-thirds of patients; the most frequently compromised areas of functioning involved attention and memory, calculation, abstraction, ability to follow complex commands, and visuospatial skills. Readministration of the NCSE prior to discharge detected a statistically significant improvement in attentional abilities, and a tendency to ward improvement for verbal comprehension and abstraction. Discussion of these findings addresses several issues: (1) the frequency and degree of impairment in this population; (2) the observed variability of cognitive functioning; (3) the question ofclinicalimprovement in neurocognitive functioning observed during a program of this length; and (4) a preference for the NCSE in this setting. The authors argue for the routine neuropsychological assessment of substance abusers, and discuss the above issues in terms of their implications for treatment at both the individual and programmatic level. Discussion of two cases illustrates the application of the NCSE, and the effect of finding organic impairment on staff attitudes and treatment issues.

ISSN:0279-1072    

DOI:10.1080/02791072.1989.10472155

出版商:Taylor&Francis Group    

年代:1989

数据来源: Taylor

摘要:

Mental health and chemical dependency clinicians have differing beliefs in regard to the etiology, diagnosis, and treatment of dually diagnosed patients. The differing views of the relationship between psychopathology and chemical dependence often result in fragmented and inadequate care, with the patient being shunted back and forth between mental health and chemical dependence treatment facilities. This article includes a discussion of the impediments to effective and comprehensive treatment for dually diagnosed patients as well as a case history to illustrate commonly encotmtered difficulties. A model treatment approach for dually diagnosed patients is described to provide clinical guidelines for effective programing. In addition, a number of recommendations identify needed changes in the mental health and chemical dependency fields at the clinical and administrative levels.

ISSN:0279-1072    

DOI:10.1080/02791072.1989.10472156

出版商:Taylor&Francis Group    

年代:1989

数据来源: Taylor

摘要:

Substance abuse among the mentally ill has become increasingly prominent. This article describes the problems presented by dual diagnosis patients in the urban, publicly funded, psychiatric emergency room. When such patients become acutely ill, neither the public health system nor the mental health clinician is adequately prepared to provide care. The inability to effectively treat these patients has become strikingly clear in recent years. In 1986, the Psychiatric Emergency Service at San Francisco General Hospital began to overflow with patients who required overnight stays. The intoxicated substance abusers with acute psychiatric complaints were the most difficult to manage clinically and administratively. Suggestions are offered for innovative approaches to this group of public patients: dual training of clinicians, flexible treatment programs prepared to deal with the whole person, and public funding that reflects patients' needs rather than clinicians' preferences.

ISSN:0279-1072    

DOI:10.1080/02791072.1989.10472157

出版商:Taylor&Francis Group    

年代:1989

数据来源: Taylor

摘要:

The pervasive use of drugs in the general population and the clearly established relationship between drug abuse and psychological disorder emphasizes the importance of diagnoses and treatment in both the mental health and the drug abuse service systems. Therapeutic community (TC) research findings on psychopathology are highlighted on the prevalence, trends, and impact of treatment, which indicate that TCs have evolved a potent model for modifying drug abuse behavior and reducing psychological symptoms. Although its success has been most evident with the primary substance abuser, the TC has much to offer the increasing numbers of dually diagnosed individuals who manifest their dysfunctionality both through drug abuse and psychological maladjustment.

ISSN:0279-1072    

DOI:10.1080/02791072.1989.10472158

出版商:Taylor&Francis Group    

年代:1989

数据来源: Taylor

摘要:

A structured model inpatient treatment program for multiple-diagnosed treatmentresistant adolescents is described. The chemical dependence disease model of Predisposition+Drug+Enabling System=Disease provides the fundamental theoretical approach. This model is elaborated and used similarly for psychiatric disorders, with examples presented. The role of psychiatric evaluation for pharmacological interventions is outlined. The psychotherapeutic treatment focuses on a commitment to abstinence as the goal. A“psychology of commitment”is described using a reframing of traditional psychotherapeutic approaches. This approach is used in conjunction with the first five steps of Alcoholics Anonymous as an empowering therapeutic model. The role of defenses, denial, confrontation, and cognitive distortions is described. The value of this approach as a neutral ground for discussion using concepts from traditional Freudian therapy, self-psychology, cognitive and learning therapies, and rational emotive therapy is elaborated.

ISSN:0279-1072    

DOI:10.1080/02791072.1989.10472159

出版商:Taylor&Francis Group    

年代:1989

数据来源: Taylor

摘要:

The diagnosis and treatment of chemically dependent adolescents with a second diagnosis of learning disabilities (LD) or an attention-deficit hyperactivity disorder (ADHD) poses a challenge. Like other so-called dual diagnoses, these conditions must be assessed against the background“noise”of the adolescent chemical dependency syndrome. This syndrome is coincident with the onset and cessation of chemical dependence and abuse. A diagnostic framework for assessing chemically dependent adolescents is presented, with specific reference to the differential diagnosis of LD and ADHD from other conditions. The role of LD and ADHD is assessed with regard to being a risk factor for chemical dependence in adolescence. Treatment approaches, on both an inpatient and outpatient basis, with the chemically dependent adolescent who also has an LD or ADHD are discussed.

ISSN:0279-1072    

DOI:10.1080/02791072.1989.10472160

出版商:Taylor&Francis Group    

年代:1989

数据来源: Taylor

摘要:

The dually diagnosed patient with attention deficit disorder, residual type (ADDRT) may be especially prone to cocaine abuse, because ADD includes dopamine deficiencies and cocaine is a dopamine agonist. It is hypothesized that bromocriptine, a dopamine agonist, will reduce a patient's craving for cocaine and simultaneously address the patient's ADD-RT symptoms. A single-organism, double-blind research design is used to evaluate the efficacy of bromocriptine, as measured by scale 9 of the MMPI, the digit span and digit symbol tests of the Wechsler Intelligence Scale-Revised, and the signaling to numbers test. Statistical analysis of the results revealed an equivocal response to bromocriptine.

ISSN:0279-1072    

DOI:10.1080/02791072.1989.10472161

出版商:Taylor&Francis Group    

年代:1989

数据来源: Taylor