摘要:

ObjectivesSubstance abuse, a multidimensional disorder, is frequently complicated by additional psychosocial needs that, left unresolved, may adversely affect clients' treatment retention and outcome. This article presents and discusses findings of a study designed to identify associations between specific wrap around services and indicators of treatment retention and posttreatment outcome.MethodsUsing data gathered in the Wrap Around Services Impact Study (WASIS) funded by the Center for Substance Abuse Treatment (CSAT), we analyzed the contribution of wrap around service receipt to multiple indicators of retention and outcome.ResultsResults of these analyses indicated a strong association between medical, educational, and mental health services and several indicators of retention. Receipt of basic needs, child care, educational, family, and medical services was associated with improvements in several posttreatment outcomes. Analyses also indicated a significant moderating role of site characteristics (i.e., program treatment individualization and intensity; program emphasis on facilitating receipt of wrap around services) on outcomes associated with wrap around service receipt.ConclusionsThe clinical implications of these findings support policies that address clients' broader biopsychosocial needs while substance abuse treatment is provided.

ISSN:1531-5754    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectivesThis article examines agreement between physicians and psychiatric inpatients on the presence of comorbid substance abuse. In addition, inpatients with comorbid substance abuse were compared on demographic and diagnostic-related symptoms with those with a single, non–substance-related disorder.MethodsAt admission and discharge, 539 patients completed self-report measures of substance use and diagnostic symptoms. Their attending physicians and nurses completed rating scales in the same time frame. In addition, physician discharge diagnoses were examined.ResultsFor 69% of patients there was agreement between patients and physicians for the absence (30.4%) or presence (38.6%) of substance abuse. For 31%, there was disagreement; 10% were those in whom physicians diagnosed substance abuse but patients denied it, and 21% endorsed substance abuse which their physicians did not diagnose. Also, those who were not substance users tended to receive more severe clinician ratings but self-reported fewer symptoms. They also were more likely to be older, have longer lengths of stay, and to have been admitted involuntarily.ConclusionsA considerable number of psychiatric inpatients are underdiagnosed for comorbid substance abuse. Multimodal means of assessment would probably enhance the inclusion of such diagnoses. Also, differences in symptoms may suggest differences in treatment regimens.

ISSN:1531-5754    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectivesThis study identified the needs of concerned significant others (CSOs) of problem gamblers in its first phase through a focus group. Based on these findings, the Community Reinforcement and Family Training (CRAFT) approach was modified into a self-help manual for CSOs of problem gamblers. In the second phase, a pilot project was designed to test the feasibility of the study design and to determine whether individuals who received the manual would show greater improvement compared with a control group.MethodsThirty-one CSOs were randomly assigned to receive the manual or a control package and were reinterviewed after three months. Variables assessed were personal and relationship functioning, number of consequences related to gambling, gambling behavior, whether the gambler entered treatment, and satisfaction with the program.ResultsThere were no group differences found in the areas of personal and relationship functioning or consequences at the three-month interview; however, participants did display significant improvement overall. Significant group differences in favor of the treatment group were found in three areas: the proportion of participants who rated gambling as decreased, those who were satisfied with the program, and those who had their needs met. Only a small proportion in each group reported that the gambler had entered treatment.ConclusionsAlthough the feasibility of the study was established, these preliminary results need to be interpreted cautiously and a replication and extension is currently underway. This type of brief intervention is a logical extension of the telephone support services offered to CSOs through hot lines in most North American jurisdictions.

ISSN:1531-5754    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Although Project MATCH failed to furnish support for the matching hypothesis in 15 of 16 instances, there are those who would argue that the results of this $27 million study support the empirical efficacy of substance abuse treatment. The problem with this argument is that Project MATCH used a selective group of participants—highly trained therapists—and failed to control for placebo or historical/maturational effects. Accordingly, the internal and external validity of pre–post differences in drinking behavior for MATCH participants is in doubt. While matching client characteristics to specific intervention strategies, as was done in Project MATCH, may not work, other forms of matching may prove more effective. Research on the therapeutic alliance is used to illustrate how matching clients to interventions based on commonalities in belief system may have a better chance of yielding meaningful results than matching client characteristics to specific treatment modalities.

ISSN:1531-5754    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectivesThis study was designed to explore correlations between single-item Visual Analog Scales (VAS) and a multiple-question Likert-type scale along with their relations to drug use in outpatients with bipolar disorder and cocaine dependence. The assessment scales included the 10-item Cocaine Craving Questionnaire (CCQ), a VAS Now and Week version, and a self-reported days of cocaine use in the past week.MethodsTwenty-nine participants diagnosed with bipolar disorder and cocaine dependence were examined from one of two previously reported 12-week studies using lamotrigine or quetiapine. The patients were evaluated at baseline and assessed either weekly or biweekly, depending on the study. To gauge the effectiveness of the drugs, the CCQ and VAS scales were administered at each visit to measure cocaine craving.ResultsTwenty-seven of the patients returned for at least one postbaseline assessment and were included in the data analysis. Significant correlations found were between VAS Now and VAS Week, VAS Now and CCQ Now, and VAS Week and CCQ Now at baseline, exit, and change from baseline to exit (allr> .53,P< .01). None of the scales correlated significantly with drug use.ConclusionsThese results suggest that for craving assessments in research and clinical settings, the faster and more easily administered VAS scales could possibly be substituted for the lengthier and more tedious 10-item CCQ. The shorter VAS scales may be valuable not only to the researcher but also to the clinician who wishes to measure a patient's craving objectively.

ISSN:1531-5754    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectivesThere is a growing body of evidence suggesting that N-methyl-D-aspartate (NMDA) receptor antagonists effectively counteract somatic and behavioral symptoms of the opioid withdrawal syndrome in humans and in laboratory animals. NMDA receptor blockade also reduces the development and expression of drug-conditioned behaviors. At present, there is only one NMDA receptor antagonist, memantine, registered for clinical use in Russia. Memantine is used in Europe for the treatment of Parkinson's disease and senile dementias. Most of heroin addicts soon after the termination of withdrawal syndrome are suffering from protracted withdrawal (syndrome of anhedonia [SA]), which includes affective disorders (depression and anxiety) and craving for heroin. SA is viewed as a major factor contributing to the relapse to heroin use.The aim of this study was to evaluate efficacy of memantine in the treatment of protracted withdrawal (SA) in recently detoxified heroin addicts.MethodsFollowing standard detoxification procedures (7–10 days), 67 heroin addicts were randomly assigned to 1 of 3 treatment groups: memantine (n = 21), amitriptyline (n = 24) or placebo (n = 22). While inpatients, subjects received one of the following medications: memantine (initial dose of 10 mg/day was gradually increased to the final dose of 30 mg/day over a period of 1 week), amitriptyline (75 mg/day), or placebo for a period of three weeks. Patients from all treatment groups received standard psychotherapy and counseling and were required to attain abstinence from heroin by providing a heroin-free urine toxicology screen prior to starting medications and at the end of each treatment week. The study design was single blind. Outcome measures included treatment retention, heroin craving (Visual Analog Scale), depression (Zung's scale), anxiety (Spielberger's scale) and anhedonia (Anhedonia syndrome scale) scores.ResultsBoth memantine and amitriptyline significantly reduced heroin craving, depression, state and trait anxiety, and anhedonia scores at the end of the three-week treatment period; placebo did not have any significant effects. The dropout rate in the memantine group was significantly lower than that in either placebo or amitriptyline groups. The average number of side effects was higher in the amitriptyline group compared with other groups.ConclusionsMemantine appears to be an effective and safe medication for protracted withdrawal (SA) and relapse prevention in recently detoxified heroin addicts. These data provide a rationale for further studies on the use of memantine in heroin dependence treatment.

ISSN:1531-5754    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1531-5754    

出版商:OVID    

年代:2002

数据来源: OVID