摘要:

AbstractThe patient population that presents with both a B-cluster personality disorder and substance abuse is a challenge to professionals in both the mental health and substance abuse treatment fields. The coexistence of both disorders is not uncommon and is frequently encountered in substance abuse treatment, social welfare, and mental health settings. The complexity of the clinical picture for these patients and their greater resistance to treatment severely taxes the practitioner's skills. Even without a clear understanding of the primary causative pathology, effective treatment modes based on a recognition of the interactive and interdependent nature of the two disorders can be developed. Part I of this two-part article presents the characteristics and clinical features of the population as well as a model for understanding some of the motivating principles behind the patient's conduct, feelings, thoughts. This is followed by guidelines for the clinician's attitude, desired characteristics, and role in dealing with this population. Part II presents guidelines for the treatment of this patient population.

ISSN:0279-1072    

DOI:10.1080/02791072.1992.10471642

出版商:Taylor&Francis Group    

年代:1992

数据来源: Taylor

摘要:

AbstractPart I of this two-part article described the characteristics and clinical features of the patient population that presents with both a B-cluster personality disorder and substance abuse. It also included guidelines for the clinician. Part II presents further recommendations for the treatment of this population, taking into account how the combination of these disorders manifests itself. The treatment approach should be kept simple and easy for patients to understand and should promote their ability to think rationally about the effect of their emotions on their behavior and its outcomes. A firm structure is critical to compensate for the lack of internal control of these patients and to prevent the manipulation that results from their view of the instrumentality of others. Denial, resistance, countertransference, and relapse to addictive behaviors are all potential barriers that are often encountered when attempting to treat this population. Group therapy with this population presents unique challenges to the clinician. As with individual therapy, a firm structure is imperative, with the clinician in charge of process and content.

ISSN:0279-1072    

DOI:10.1080/02791072.1992.10471643

出版商:Taylor&Francis Group    

年代:1992

数据来源: Taylor

摘要:

AbstractInjecting practices of illicit drug users in San Antonio, Texas, were studied by means of informal field interviews and participant observation. The methods injection drug users (IDUs) employed to obtain drugs seemed to affect their HIV risk behaviors. Many of the methods involve reciprocal exchanges between a person who has drugs and a person who wants drugs. The exchanges frequently occur in the context of asymmetrical social interactions. The person with the drugs usually occupies the dominant role in the interaction and determines the needle hygiene for both parties. Analysis of the decision-making process of IDUs indicates that the party in the dominant role may choose not to disinfect a syringe for a variety of reasons. An understanding of the subcultural rules that govern these interactions may provide valuable clues to researchers or educators who are designing interventions aimed at reducing HIV risk behaviors among IDUs. This research suggests that for IDUs in subordinate roles, education alone may be insufficient to produce behavior changes necessary to eliminate risk of HIV infection.

ISSN:0279-1072    

DOI:10.1080/02791072.1992.10471644

出版商:Taylor&Francis Group    

年代:1992

数据来源: Taylor

摘要:

AbstractThis article discusses conducting psychotherapy with alcoholics in light of the controversy about whether alcoholism is a disease. The belief that alcoholism is a disease forces many clinicians to offer abstinence from alcohol as the only option for alcoholics who seek treatment. From this perspective, the alcoholic must be helped to accept the idea that he or she has a disease and that to recover from this problem, drinking must stop. Others maintain that alcoholism may not be a disease and view alcoholic drinking as maladaptive behavior. From this vantage point, helping the patient to control or to moderate drinking might be considered. These two distinct paradigms lead to divergent treatment goals, which leaves the clinician in a quandary about how best to treat an individual who experiences a drinking problem. To resolve this dilemma, it is suggested that the clinician who works with alcoholics entertain a multiplicity of perspectives and should not be blinded by any one paradigm. While control of alcohol intake must take place if such patients are to improve their functioning, the author argues that recovery can occur either by abstinence or through moderating drinking.

ISSN:0279-1072    

DOI:10.1080/02791072.1992.10471645

出版商:Taylor&Francis Group    

年代:1992

数据来源: Taylor

摘要:

AbstractThis article focuses on the management of stigma by methadone maintenance patients. It explores (1) the consequences of this persistent stigma, which necessitates the need for secrecy, (2) the adaptations made in order to successfully“pass as normal,”and (3) the contexts in which methadone-maintained individuals decide to disclose their stigmatized status. The data reported and analyzed were gathered between 1980 and 1989 during a series of studies funded by the National Institute on Drug Abuse. The three studies—“Women on Methadone,”“Getting Off Methadone,”and“Alameda County Methadone Study”—utilized qualitative, in-depth interviews and ethnographic sampling techniques, primarily chain referral sampling. After ten years of interviewing women and men in various stages of their methadone maintenance careers, recurring themes emerged, one of which was that being a methadone patient is a marginal identity; not quite junkie, not quite conventional. Clients' efforts to manage this stigmatized identity were often shrouded in anguish and secrecy. Methadone patients were in a kind of identity limbo; a holding pattern between two extremely different social worlds. They were trying to effect an identity transformation; however, in many circumstances they were still associated with and defined by their“dirty secret.”

ISSN:0279-1072    

DOI:10.1080/02791072.1992.10471646

出版商:Taylor&Francis Group    

年代:1992

数据来源: Taylor

摘要:

AbstractThis article offers a perspective on the use of volatilized alkaloidal cocaine in its free base and crack forms and on the pulmonary consequences of such use. The inhalational route of administration of free base and crack cocaine exposes the lung to their combustion products, raising concern about possible adverse pulmonary effects. A brief historical review of cocaine and its methods of use precedes the presentation of data concerning current modes and patterns of use and some pulmonary complications of crack and free base use. Results from a systematic study of a large sample of cocaine users document a high frequency of occurrence of acute respiratory symptoms in temporal association with cocaine smoking. No relationship was detected between the prevalence of acute pulmonary symptoms and identifiable aspects of techniques of cocaine administration. These results suggest that the respiratory consequences of alkaloidal cocaine are most likely attributable to the inhaled cocaine itself, rather than to variable characteristics of usage.

ISSN:0279-1072    

DOI:10.1080/02791072.1992.10471647

出版商:Taylor&Francis Group    

年代:1992

数据来源: Taylor

ISSN:0279-1072    

DOI:10.1080/02791072.1992.10471648

出版商:Taylor&Francis Group    

年代:1992

数据来源: Taylor

ISSN:0279-1072    

DOI:10.1080/02791072.1992.10471649

出版商:Taylor&Francis Group    

年代:1992

数据来源: Taylor

ISSN:0279-1072    

DOI:10.1080/02791072.1992.10471650

出版商:Taylor&Francis Group    

年代:1992

数据来源: Taylor

ISSN:0279-1072    

DOI:10.1080/02791072.1992.10471651

出版商:Taylor&Francis Group    

年代:1992

数据来源: Taylor