摘要:

We investigated the outcomes of a 21-day inpatient drug detoxification and rehabilitation program including length of stay, transfer to further treatment, and HIV risky behavior. Clients (n= 567) were predominantly White, male, currently unemployed, and their treatment was not covered by third party payment. 78% were detoxified with methadone. The median length of stay was 18 days. Higher education, not living with spouse or children, English as primary language, admission during fall or winter months, and greater knowledge of HIV transmission were independent predictors of greater length of stay. Among those with follow-up (n= 450), 19% were transferred to residential drug-free programs and 7% to outpatient programs. Taking into account loss to follow-up, the overall rate of treatment transfer could be as low as 21%. Greater length of stay was associated with higher rates of transfer to residential treatment. Relapse rates to either any drug use or injection drug use were lower among subjects transferred to residential treatment than either clients transferred to outpatient programs or those with no further treatment. Among subjects who continued to inject drugs at follow-up, no reduction in HIV risky behaviors was found regardless of further treatment. We conclude that detoxification programs have the potential for reducing relapse to drug use when followed by residential drug-free treatment.

ISSN:0095-2990    

DOI:10.3109/00952999509095225

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

This study used the Addiction Severity Index (ASI) to identify the various problems substance abuse clients present when seeking treatment at a Department of Veterans Affairs Medical Center. The sample was 98% male and 73% African-American, with a mean age of 37 years. Cluster analysis was used to identify commonalities and divergences in self-reported employment, legal, family, substance abuse, psychological, and medical problems. Four distinct clusters emerged, each of which could be characterized by a dysfunctional pattern. The utility of this approach in designing treatment regimens, addressing client problems in addition to their substance abuse, increasing client satisfaction with service provided, and decreasing treatment attrition is discussed.

ISSN:0095-2990    

DOI:10.3109/00952999509095226

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

During the past quarter-century there have been innumerable reports throughout the world documenting the effectiveness of methadone maintenance treatment. None have been as consistently positive as those from Germany, where just a few years ago methadone was effectively banned. The German accomplishments in the past 6 years in treating addicts with methadone confirm the experience elsewhere: Methadone treatment is a highly desired alternative to many who wish to escape the life of the street addict; it is very effective in benefiting the individual patient as well as the general community; and it can be expanded rapidly and on a large scale. What is needed today is not further discussion but a firm commitment to make treatment available on request to every addict willing to accept it. With methadone maintenance—one treatment approach among many—this goal is achievable. There is no justification for settling for less.

ISSN:0095-2990    

DOI:10.3109/00952999509095227

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

Questions have arisen about the implications of notifying drug abusers of their HIV serostatus. One major concern is that awareness of HIV infection would have a negative impact on abstinence from drug abuse. In order to ascertain the effects of serostatus notification, the authors reviewed the clinical records of 73 methadone patients who learned of their serostatus within 20 weeks after enrolling in the clinic and thereafter remained in treatment for at least 1 year. They found that, at serostatus notification, seropositive patients were more likely to be socially disadvantaged and were younger than the seronegatives at first opiate use. After serostatus notification, seropositives had more“fair hearings”for noncompliance with program norms and used more cocaine. Although the patients notified of HIV infection may have more behavioral problems, further research is needed to determine whether or not this reflects antecedent behavior patterns and drug use.

ISSN:0095-2990    

DOI:10.3109/00952999509095228

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

Naloxone (0.8 mg, s.c.) effects on opiate withdrawal signs and symptoms and regional brain function were assessed in 10 methadone-maintained patients and 10 healthy subjects in a double-blind, placebo-controlled study. Regional brain function was assessed using single photon emission computerized tomography (SPECT) by evaluating the uptake of [99mTc]d, l-hexamethylpropyleneamine oxime (HMPAO) in the brain, a process related to regional cerebral perfusion. Comparisons of patients and healthy subjects after saline infusion suggested that chronic opiate dependence was associated with lower corrected activity ratios (regional count density/whole brain count density) in frontal and parietal cortices and greater activity ratios in the thalamus. Opiate-dependent patients, but not healthy subjects, developed opiate withdrawal signs and symptoms after naloxone administration. Following naloxone administration, patients undergoing opiate withdrawal exhibited lower whole brain count density than healthy subjects. They also had lower activity ratios in frontal and parietal cortices and increased thalamic activity ratios relative to healthy subjects receiving naloxone. Naloxone administration in healthy subjects, but not opiate withdrawal in patients, was associated with decreased right parietal cortex and increased right temporal cortex and left basal ganglia activity ratios. Relative to naloxone effects in healthy subjects, opiate withdrawal was associated with decreased whole brain count density and a reduced right temporal cortex activity ratio. This preliminary study reports an initial evaluation of HMPAO-SPECT imaging for assessing regional alterations in brain function during opiate dependence and withdrawal. While group differences were reported, the small magnitude of regional alterations in patients undergoing opiate withdrawal raised concern that HMPAO-SPECT methods employed were inadequate for assessing human regional brain function during phases of opiate addiction. Other emerging functional brain imaging technologies should be evaluated relative to improved HMPAO-SPECT methods for this purpose.

ISSN:0095-2990    

DOI:10.3109/00952999509095229

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

Twenty-nine cocaine-dependent male veterans without other drug dependence completed a double-blind controlled, randomly-assigned study examining the efficacy of bromocriptine versus placebo in the management of cocaine abstinence symptomatology. Serum prolactin (PL) and growth hormone (GH) levels were obtained prior to and after the study was completed. Patients were seen daily and completed several self-report questionnaires, including the Symptom Checklist-90-Revised, the Beck Depression Inventory, and a Cocaine Craving Report. The patients were also asked to rate a variety of cocaine withdrawal symptoms. Overall, there did not appear to be any advantage to receiving bromocriptine versus placebo during the first 3 weeks following cocaine use cessation with the possible exception of changes in activity and appetite level. The placebo group showed a statistically significant increase in activity level during the first week in treatment and a significant increase in appetite throughout the study. Patients in both groups showed significant improvement in the other areas assessed, with improvement appearing to progress according to length of treatment. Hyperprolactinemia or abnormal GH levels were not found in this patient sample as a group. Thirty-four of the original 63 patients dropped out of the study. Seventeen received bromocriptine, and 17 received placebo. There was no significant difference between drug groups in incidence of retaining patients in treatment. The high dropout rate may reflect the difficulty incurred in retaining cocaine-dependent patients in treatment.

ISSN:0095-2990    

DOI:10.3109/00952999509095230

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

Motivational and decisional models suggest that those who seek help for substance use problems may differ from those who do not seek help in terms of their belief that substance use is creating social and personal negative consequences and their perceived dependence. In this study, help seeking for cocaine use was hypothesized to be a function of the negative consequences from cocaine, perceiving oneself as dependent on cocaine, quantity and frequency of use, cost of use, and route of administration. A sample of 161 substance abusers in treatment who had used any cocaine in the last 6 months completed questionnaires regarding the quantity, frequency, history, and perceptions of the consequences of their cocaine use. Of the 161 subjects, 113 (70.2%) had at some time sought help from someone for their cocaine use. After controlling for marital and employment status, a logistic regression revealed that the number of negative consequences experienced, feeling dependent on cocaine, and the amount of cocaine used were associated with seeking help for cocaine use. Additionally, a logistic regression was performed to determine factors associated with cocaine users' reporting that they feel dependent on cocaine. Significant variables included number of negative consequences experienced and frequency of use. Consistent with motivational and decisional models, results suggest that clients' motivation to seek help for cocaine use is related primarily to adverse consequences of use. Theoretical and clinical implications of results are discussed.

ISSN:0095-2990    

DOI:10.3109/00952999509095231

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

We studied 3,942,868 Medicare patients (comprised of elderly and disabled) discharged with cardiovascular disease (CVD) during 1987, of which 41,095 (1%) had a drug disorder. Among this small subgroup, the percent of those overlapping with an alcohol and/or mental disorder is 33% for the elderly and 47% for the disabled. The presence of a drug disorder discharge diagnosis is associated with an excess of 329,650 days of hospital care and $174,498,071 in hospital charges as illustrated by a 51% increase in average annual days in the hospital for the elderly, and a similar 61% increase for the disabled. The concomitant increase in average annual discharges offers an explanation. Clinical progression in drug disorder severity (six categories were defined) is associated with increasing lengths of stay; for example, drug dependence comorbidities present longer lengths of stay than drug abuse comorbidities. Among the 12 categories of CVD defined, patients with rheumatic heart disease, hypertensive heart disease, hypertension, and other venous disorders were those whose length of stay experienced the largest percent increase when a drug disorder was present. When drug disorders compete with alcohol and/or mental disorders in a general linear model predicting average annual length of stay, they remain significant at thep<. 001 level.

ISSN:0095-2990    

DOI:10.3109/00952999509095232

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

Research has shown that drug abuse treatment can help many individuals. Yet funding is often lacking for treatment because these programs compete for scarce resources with other important and effective social programs. This study shows how drug abuse treatment programs can be made more attractive to decision makers and funding agencies by first highlighting why economic evaluation is a critical component of drug abuse treatment research. Next, an evaluation methodology is presented that can be followed by program staff and researchers. The evaluation methodology includes aspects of cost-and-outcome analysis, cost-effectiveness analysis, and benefit-cost analysis. Methods and findings are then discussed from most of the major economic evaluation studies of drug and alcoholism treatment. Lastly, guidelines for conducting future economic evaluations are presented along with suggestions for how the results can be used for policy purposes and program planning.

ISSN:0095-2990    

DOI:10.3109/00952999509095233

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

This exploratory study used data on admissions to a 28-day residential addiction treatment program to explore differences between disabled and nondisabled cases with respect to patterns of substance use and other characteristics. Relationships between length and type of disability, substance use, and other characteristics were also explored. The focus was on cases aged 18 to 65 identified as having physical disabilities that limit participation in the work force. The results showed that 5.3% of the sample reported disabilities which prevented them from working, and a further 8.6% reported that physical disabilities limited their participation in the work force. The results also showed that self-identified problems with tranquilizers were more common among the disabled than the nondisabled and that more severely disabled people are more likely to report attempting suicide and to express the need for mental health counseling. Having prescriptions as a main source of drugs was also more common among females with major disabilities than among other groups. Priorities for further research are suggested.

ISSN:0095-2990    

DOI:10.3109/00952999509095234

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor