摘要:

In this concept paper, the authors review the arguments and evidence for the hypothesized link between the alcohol withdrawal syndrome and the anxiety and craving that occurs during abstinence in alcohol‐dependent patients. This hypothetical construct suggests that the repeated experience of alcohol withdrawal and its associated limbic‐neuronal discharge induces a permanent state of limbic hyperexcitability. This phenomenon has been referred to as “kindling.” Subsequent episodes of limbic discharge may then be precipitated during abstinence by alcohol‐related cues or may even occur spontaneously. Subjectively experienced as anxiety or craving, such a neuronal discharge could provoke relapse to drinking in vulnerable subjects. The clinical, neurochemical, and electrophysiologic rationale for this hypothesis will be presented, along with implications for treatment and suggested futur

ISSN:1055-0496    

DOI:10.1111/j.1521-0391.1995.tb00254.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The authors evaluated the effects on retention and other outcomes of three approaches in a methadone maintenance program. At the time of admission, 300 chronic opioid users were randomly assigned to standard treatment, patient‐regulated dose, or optional counseling. Retention of the optional counseling group exceeded that of the other two groups, but the difference was only of borderline significance. Allowing patients to regulate their methadone dose did not lead to a general escalation of dose. Subjects in optional counseling saw their counselors less than half as often as those in the standard treatment with two mandatory sessions per month. Illicit drug use and social performance in the twelfth month did not differ significantly among the three subgroups that remained in treatment. The findings support patient participation in decisions about methadone dose and the frequency of counselin

ISSN:1055-0496    

DOI:10.1111/j.1521-0391.1995.tb00255.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Forty‐seven psychiatric inpatients with concurrent RDC‐diagnosed schizophrenia and psychoactive substance use disorders were randomly assigned to one of two outpatient treatment programs: 1) integrated psychiatric and substance abuse treatment; or 2) non‐integrated treatment. Patients abused cocaine, alcohol, and marijuana, with over two‐thirds using all three drugs. At 4 months, 16 of 23 patients (69.6%) in integrated treatment remained in treatment vs. 9 of 24 (3 7.5%) in the nonintegrated treatment. Rehospitalization did not differ between groups, but treatment nonstarters had significantly more days in the hospital than those who began treatment. At 8 months, addiction and psychiatric severity decreased significantly for patients remaining in treatment. Engagement in integrated outpatient treatment may decrease rehospitalization, and lessen psychiatric and substance abuse s

ISSN:1055-0496    

DOI:10.1111/j.1521-0391.1995.tb00256.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Adolescent alcohol and drug use are associated with many negative consequences. Understanding factors in initiation and patterns of use could aid in treatment and prevention. Sixty‐four adolescents calling a cocaine hotline received structured telephone interviews. Mean age was 16.7 years. Two‐thirds of the adolescents were young men. Sixty‐six percent used alcohol; 60.9%, marijuana; 60.9%, cocaine; mean onset was at 13.57, 13.28, and 14.64 years, respectively. Daily use of alcohol was reported by 25.8%; marijuana, 36.9%; and cocaine, 41.3%. Eighty‐four percent tried drugs because of peer pressure. Multiple alcohol/drug use commonly started in early adolescence. Peer use and pressure were major reasons for initiation. Early interventions can incorporate and make use of these

ISSN:1055-0496    

DOI:10.1111/j.1521-0391.1995.tb00257.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The impact of motivational factors on AIDS high‐risk behavior after participation in an AIDS intervention program was explored among 208 out‐of‐treatment injecting drug users (IDUs). It was hypothesized that lower risk behavior would be evident at follow‐up among IDUs who indicated higher concern about their susceptibility to AIDS prior to intervention. Results showed that this motivational indicator predicted lower risks 6 months after the intervention. Overall, this study indicates that psychoeducational AIDS interventions will be most beneficial to individuals with sufficient cognitive readiness to address drug‐ and AIDS‐related issues at a personal level. Assessments of risk and motivation levels of program participants should be used to tailor intervention strategies to meet indiv

ISSN:1055-0496    

DOI:10.1111/j.1521-0391.1995.tb00258.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The authors used a randomized clinical trial to compare enhanced vs. standard methadone maintenance for pregnant opiate‐addicted women. Although there were no differences by treatment group in maternal drug use, women in the enhanced program had three times as many prenatal care visits, had longer gestations, and had infants of higher birth weigh

ISSN:1055-0496    

DOI:10.1111/j.1521-0391.1995.tb00259.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The authors examined the psychosocial correlates of 1) having a history of any type of psychiatric treatment and 2) being staff‐identified as a suitable candidate for treatment from an outpatient dual‐diagnosis program. They reviewed 1,303 consecutive patients in a 16‐month period who applied for substance abuse and/or dual‐diagnosis treatment at a Veterans Administration hospital. The sample included 665 individuals describing a history of prior psychiatric treatment, 126 of whom were referred for outpatient dual‐diagnosis treatment. Data were collected at the time of treatment application and included demographics, employment and treatment histories, and recent substance use. Even the broadest definition of dual diagnosis (having a history of any type of psychiatric treatment) was associated with higher rates of homelessness, disconnection from social support systems, unemployment and vocational disability, and treatment chronicity; a narrower definition selected for even greater impairment. Substance abuse programs should anticipate significant case management needs in addition to psychiatric support when treatment programs are expanded to include services to patients with comorbid psychiatri

ISSN:1055-0496    

DOI:10.1111/j.1521-0391.1995.tb00260.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

One hundred consecutive admissions to an intensive outpatient cocaine treatment clinic in Camden, NJ, were assigned DSM‐III‐R Axis I and II psychiatric diagnoses by means of the SCID. Prevalence rates for non‐substance‐use Axis I disorders were equivalent to expected population base rates. By far the most common diagnoses were on Axis II (73% of subjects), with over one‐third of subjects receiving more than one personality disorder diagnosis, frequently crossing DSM‐III‐R “clusters.” In the distribution of psychopathology, certain gender differences were noted. The authors discuss implications for the clinical management and treatment of cocaine‐addicted individuals in

ISSN:1055-0496    

DOI:10.1111/j.1521-0391.1995.tb00261.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Medical records of 125 geropsychiatric inpatients were reviewed for a pilot study of the prevalence and medical and psychosocial correlates of chemical dependence and/or abuse. Patients were studied in three groups, each corresponding to the phased implementation of a program to enhance staff awareness of these problems. In contrast to patients without chemical dependence/abuse diagnoses, patients with these diagnoses had shorter lengths of stay, a greater number of psychiatric diagnoses, and were more likely to show personality disorder. Inception and implementation of the staff awareness program was associated with finding a significantly greater number of patients with chemical dependence/abuse diagnoses.

ISSN:1055-0496    

DOI:10.1111/j.1521-0391.1995.tb00262.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Recent research has shown that comorbid cocaine abuse and attention deficit hyperactivity disorder (ADHD) occur frequently in clinical populations. These patients are challenging, both diagnostically and clinically, but may respond to combined standard treatment for ADHD and cocaine abuse.

ISSN:1055-0496    

DOI:10.1111/j.1521-0391.1995.tb00263.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY