摘要:

AbstractNumerous factors will affect the course of alcohol-drug services over the next decade, including technological-scientific advances, legislation, professional training standards, case law, availability and cost of substances, and social policy toward users. Despite some apparent lessening of substance use, high levels of substance abuse are likely to continue due to fetal damage in high-risk offspring, younger onset of substance abuse, and solo-parent families. Care givers must be prepared to treat more youth, elderly, women, minority, and“dual disorder”patients. Federal and local statecraft against substance production and use remains crude and does not show signs of the increasing sophistication observed elsewhere in the world. Although these forces favor continued high levels of substance abuse problems, the funding mechanisms to provide care are under increasing assault by both the private and public sectors. Areas in which professional practice are apt to improve include clinical assessment-reassessment, treatment outcome research, monitoring during recovery, and outpatient treatment. Professional groups and treatment organizations will become more proactive in the financial support and management of treatment services.

ISSN:0095-2990    

DOI:10.3109/00952999209001606

出版商:Taylor&Francis    

年代:1992

数据来源: Taylor

摘要:

AbstractWe studied the self-reported temporal sequence of cocaine-related problems in 45 male predominantly Black (85%), lower SES cocaine addicts undergoing inpatient treatment at a large urban VA psychiatric hospital. Subjects reported recent average use of 2.5 g of cocaine per day for 14 days each month and experiencing a mean of 14 cocaine-related problems. The temporal sequence of cocaine-related problems was roughly consistent with the sequence of alcohol-related problems reported for alcoholics, with the earliest problems being interpersonal (e.g., arguments with others) and the most recent problems the severest (e.g., job loss, marital separation). The cocaine addicts showed a faster progression from first cocaine use to first cocaine-related problems (mean of 3.75 years) than that reported for alcoholics from first drink to first heavy drinking (8-10 years). Cocaine smokers had a faster course (3.4 years) than intranasal users (5.3 years).

ISSN:0095-2990    

DOI:10.3109/00952999209001607

出版商:Taylor&Francis    

年代:1992

数据来源: Taylor

摘要:

AbstractThree recreational cocaine users (age, 26.7 years), after one adaptation night, spent 5 days and nights in the laboratory where their EEG, EOG, and submental EMG were recorded during all of their sleep. On the second afternoon and evening of the study, subjects used an estimated 1 to 2 g cocaine intranasally. They all slept between 2:00 A.M. and 9:00 A.M. that night. Blood samples were drawn each evening and morning. Absolute plasma cocaine levels and patterns of elimination were consistent with subjects report of dose and time of administration. Mood ratings were made repeatedly throughout the study. There was suppression of REM sleep during the use of cocaine followed by a rebound which is specific to REM sleep and is not seen in other stages of sleep. REM variables subsided to normal levels on the third recovery night following cocaine use.

ISSN:0095-2990    

DOI:10.3109/00952999209001608

出版商:Taylor&Francis    

年代:1992

数据来源: Taylor

摘要:

AbstractRetention in outpatient psychotherapy of 148 crack and cocaine abusers was examined. The clients were predominantly Black (63%) and Hispanic (21%), predominantly male (87%), and the majority (66%) had completed no more than 12 years of high school. Clients entered treatment in a low-cost treatment center in New York City between June 1987 and November 1988. Forty-two percent (62) of the subjects were seen for one or two research interviews only, and did not return to begin therapy. Of the 86 persons who came to at least one therapy session, 30% (26) dropped out before the third session, 28% (24) dropped out between the third and fifth sessions, and 42% (36) were retained for six or more sessions. Short-term and longer-term retentions were analyzed separately, using a battery including sociodemographic variables, treatment history, psychiatric symptomatology, number of arrests, and drug use variables. None of the variables considered was significantly related to short-term retention. There were large although not significant differences in longer term retention by therapist. Longer-term retention was associated significantly with being White (contrasted with being Black) and being young. Nonsignificant but large associations were found between longer-term retention and having few arrests, being Hispanic (contrasted with being Black), and having low SCL-90 scores. Results are compared with previous findings about retention in drug and alcohol treatment. It is suggested that future research on retention in treatment focus less on client variables and more on therapist and program variables.

ISSN:0095-2990    

DOI:10.3109/00952999209001609

出版商:Taylor&Francis    

年代:1992

数据来源: Taylor

摘要:

AbstractCrack is a rock crystalline alkaloid form of cocaine which can be smoked. At the University of Minnesota, we have developed an experimental pharmacologic treatment for cocaine abusers. Of 26 patients treated to date, 16 have been crack cocaine users. During the hundred days preceding treatment, the 16 crack subjects used cocaine by all routes an average of 71 days each. Improvement was based on a self-reported decrease in cocaine frequency of use. Using carbamazepine, seven highly successful and six partially successful patients reduced their use to 0.7 days and 26 days per 100 days, respectively. These results, though hopeful, must be viewed with caution and considered preliminary and tentative.

ISSN:0095-2990    

DOI:10.3109/00952999209001610

出版商:Taylor&Francis    

年代:1992

数据来源: Taylor

摘要:

AbstractThe incidence of panic attacks methadone-maintained patients has increased over a 10-year period from 1 to 6-13%. Cocaine use appears to be associated with this increase, although other environmental and constitutional factors may be contributory. Patients with cocaine-associated panic differ from other panic patients in rates of psychiatric hospitalization and medical illness, but not in depression, other drug use, or agoraphobia.

ISSN:0095-2990    

DOI:10.3109/00952999209001611

出版商:Taylor&Francis    

年代:1992

数据来源: Taylor

摘要:

AbstractWhile maintained on methadone, heroin users reduce their heroin use and related criminal activity and increase their legitimate employment. These benefits are obtained at the cost of continued opioid dependence. Furthermore, as a consequence of neural adaptation and conditioning, methadone maintenance may impede eventual recovery from opioid dependence. The authors attempt to assess such a possible effect by comparing long-term outcomes after methadone maintenance with those after drug-free treatment. In five long-term follow-up studies of methadone maintenance, the percentages found voluntarily abstinent ranged from 9 to 21. In six long-term follow-up studies of drug-free treatment, the percentages found voluntarily abstinent ranged from 10 to 19. These rates seem remarkably similar. They do not suggest that methadone maintenance impedes eventual recovery from opioid dependence, but they do not clearly exclude such an effect.

ISSN:0095-2990    

DOI:10.3109/00952999209001612

出版商:Taylor&Francis    

年代:1992

数据来源: Taylor

摘要:

AbstractAmong 386 consecutive patients hospitalized for substance abuse, 15% of 143 women had a lifetime diagnosis of anorexia or bulimia nervosa, compared to only 1 % of 243 men. Women with eating disorders had significantly higher rates of stimulant abuse and lower rates of opioid abuse than women without eating disorders.

ISSN:0095-2990    

DOI:10.3109/00952999209001613

出版商:Taylor&Francis    

年代:1992

数据来源: Taylor

摘要:

AbstractSocial support is becoming recognized as a positive influence on health and health maintenance. Forms of support which bolster the patient's sense of personal efficacy should enhance the alcoholic's ability to cope with a specific stressor (i.e., overcoming his or her addiction). Patients reporting higher levels of social support during alcoholism treatment, especially support that enhances his or her self-esteem, should therefore demonstrate improved outcome compared to patients with lower levels. Sixty-one consecutive admissions to an inpatient alcoholism treatment program at a rural midwestern medical center completed an assessment of six forms of social support (Guidance, Reliable Alliance, Reassurance of Worth, Opportunity for Nurturance, Attachment, and Social Integration) in terms of support obtained from family and friends and from the treatment environment. For each patient, additional information concerning age, marital status, financial support, and previous alcohol-related hospitalizations was also obtained. Outcome of treatment was measured by readmission for an alcohol-related diagnosis within 1 year of discharge. Survival analysis found that reassurance of worth from family and friends and number of previous hospitalizations were independent and significant predictors of time to readmission. Higher levels of reassurance of worth or esteem support significantly lengthened time to readmission, with the reverse relationship found for number of previous hospitalizations. These results suggest that specific sources (family and friends) and forms (reassurance of worth) of social support are important to the recovering alcoholic and that the effect of social support on treatment outcome is independent of the alcoholic's history of prior treatment failure. Interventions or program modifications should be designed specifically to bolster these facets of social support rather than addressing more general forms of support.

ISSN:0095-2990    

DOI:10.3109/00952999209001614

出版商:Taylor&Francis    

年代:1992

数据来源: Taylor

摘要:

AbstractProblem-drinker drivers who drank at multiple locations differ substantially from those who drank at only one location. Persons who drank at more than one location prior to their DWI arrest exhibit the most severe alcohol problems. Multilocation drinkers consumed significantly greater amounts of alcohol–for nearly all alcohol measures including consumption per drinking day, consumption averaged over 30 days, and consumption on the day of the DWI arrest–than single location drinkers. The multilocation group experienced more alcohol problems in their lives, had higher Mortimer-Filkins test scores, were intoxicated more frequently, and had a greater probability of a DSM-FH-R alcohol-dependence diagnosis. Compared to the single location drinkers, the multilocation group had more bad driving incidents, frequently (once a week) drove while drunk, and expressed the attitude that the DWI had less of an impact on their lives. The findings suggest that multilocation drinkers require intensive interventions.

ISSN:0095-2990    

DOI:10.3109/00952999209001615

出版商:Taylor&Francis    

年代:1992

数据来源: Taylor