bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient Treatment Choice and Compliance
Authors: Sterling Robert C. , Gottheil Edward , Glassman Scott D. , Weinstein Stephen P. , Serota Ronald D.
Published: February 2010

The authors tested the hypothesis that patients (treatment‐seeking cocaine‐dependent persons) given the opportunity to choose between treatment approaches would do better than patients randomly assigned to the same approaches in treatment retention and 9‐month outcome. Subjects were 34 patients who voluntarily chose to enter individual therapy 1 hour per week (IND) and 33 who chose intensive group therapy for 3 hours, 3 times weekly (INT). There were no significant differences between these two groups on demographic, personality, or addiction severity variables or in treatment retention or 9‐month outcome. Comparison with samples of 30 patients who had been randomly assigned to IND and 30 to INT did not confirm the hypothesis that patients who chose their treatment would either remain in treatment for longer periods of time or manifest improved 9‐month outcomes. The authors raise several motivational issues.
Does ADHD Affect the Course of Substance Abuse?:Findings From a Sample of Adults With and Without ADHD
Authors: Wilens Timothy E. , Biederman Joseph , Mick Eric
Published: February 2010

The authors examined the effects of attention‐deficit hyperactivity disorder (ADHD) and psychiatric comorbidity on recovery from psychoactive substance use disorder (PSUD) with 130 referred adults with ADHD and 71 non‐ADHD adults, all of whom had a lifetime history of PSUD. Although PSUD remitted in 80% of both groups, the rate of remission and duration of PSUD was quite different in the ADHD vs. non‐ADHD subjects. The duration of PSUD was 37.2 months longer in the ADHD than in non‐ADHD subjects. The median time to PSUD remission was more than twice as long in ADHD than in control subjects (144 vs. 60 months, respectively). ADHD is associated with a longer duration of PSUD and a significantly slower remission rate. If confirmed, such findings extend previous work showing that ADHD is a risk factor for early initiation and specific pathways of PSUD, providing further evidence of the relevance of this association. (Am J Addict 1998; 7:156–163)
A Pilot Open Randomized Trial of Valproate and Phenobarbital in the Treatment of Acute Alcohol Withdrawal
Authors: Rosenthal Richard N. , Perkel Charles , Singh Prameet , Anand Om , Miner Christian R.
Published: February 2010

The authors conducted a randomized, open comparison of the GABAergic anticonvulsant sodium valproate (divalproex sodium; Depakote) and phenobarbital as an active control in the management of acute withdrawal from alcohol. Repeated measures ANOVA was used to assess treatment effects in the first 37 inpatients, evaluating mood, hostility, and subjective and objective measures of withdrawal at index, 3, and 5 days of detoxification. Subjective and objective ratings of abstinence symptoms and subjective mood disturbance decreased significantly in intensity in both groups over 5 days, but there were no significant treatment differences nor treatment by time interactions. Hostility scores did not differ overall, but a group by time effect was observed (F = 5.42, df=[1,13], P<0.05), with phenobarbital subjects reporting less hostility/ aggression than those in the valproate group. There were no withdrawal‐related seizures or other acute sequelae. This study offers pilot confirmation that sodium valproate is as effective as phenobarbital in the management of acute alcohol withdrawal, but it is unclear whether valproate offers a clinical advantage with respect to stabilizing changes in mood and interpersonal hostility during detoxification.
The Pharmacotherapy of Relapse Prevention Using Anticonvulsants
Authors: Kosten Thomas R.
Published: February 2010

This review of anticonvulsants for relapse prevention in substance abusers focuses on a series of clinical trials among cocaine abusers. Based on a preclinical rationale linking kindling with drug craving, several studies by Halikas et al. found reductions in cocaine use and craving among “compliant” subjects with blood levels above 4 μ/ml. Three independent randomized trials found no difference from placebo in cocaine use, although treatment retention may be higher during the first 6 weeks, and alcohol use might be less at follow‐up after medication discontinuation.
Treatment of Comorbid Affective and Substance Use Disorders: Therapeutic Potential of Anticonvulsants
Authors: Donovan Stephen J. , Nunes Edward V.
Published: February 2010

The authors examine the use of anticonvulsants/mood stabilizers to treat patients with substance use disorders. Although there is high comorbidity of bipolar and substance use disorders, there has been little research on the use of these medications to treat bipolar disorders in patients who also have a substance use disorders. However, symptoms of bipolar disorders, such as irritability and mood lability, may be difficult to distinguish from the effects of acute and chronic substance use; therefore, reliable diagnostic methods will need to be developed. Further, a new, hypothesized syndrome, Explosive Mood Disorder, is described that may be distinct from the bipolar spectrum. It is characterized by childhood onset of temper outbursts and irritable mood that persists into adolescence and adulthood, is connected to marijuana use, and responds to divalproex sodium. The authors review studies of prevalence, comorbidity, family history, longitudinal course, and placebo‐controlled trials of anticonvulsant medications to evaluate the validity and treatment implications of this proposed entity.
Stimulant Use in Sports
Authors: Jones Alison R. , Pichot John T.
Published: February 2010

The authors provide an overview of the topic of stimulant use in psychiatric sports medicine. They address the following areas: 1) the history of stimulant use in sports; 2) recent events related to the use of stimulants in sports, including a new stimulant used at the 1996 Olympic competition in Atlanta, GA; 3) ergogenic or ergolytic (i.e., performance‐impairing) potential of several major categories of stimulants, including amphetamines, beta2agonists, caffeine, and cocaine; 4) review of how the brain reward circuit is affected by stimulants; 5) individual factors that induce athletes to utilize stimulants; and 6) sports organizational factors that induce athletes to use stimulants.
Reliability and Validity of the Aggregate Method of Determining Number of Cigarettes Smoked Per Day
Authors: Gariti Peter W. , Alterman Arthur I. , Ehrman Ronald N. , Pettinati Helen M.
Published: February 2010

The authors evaluated the reliability of two pretreatment assessments (screening and intake) of cigarettes smoked per day (CPD) by the commonly used aggregate method. The validity of the aggregate method was also determined by comparison with results of the timeline followback (TLFB) method for the identical periods. The study participants were 49 outpatients undergoing nicotine patch treatment. The reliability of the two aggregate method evaluations of CPD was quite high by Pearson product‐moment correlation (r) and good when based on the intraclass correlation. Correspondence between the CPD assessments based on the aggregate and TLFB methods for the two time‐points ranged from fair (screening) to good (intake). Overall, the study findings indicate that the aggregate method provides reasonably consistent data.
Diagnosis of Personality Disorders in Cocaine‐Dependent Individuals
Authors: Sonne Susan C. , Brady Kathleen T.
Published: February 2010

The authors explored the relationship between personality disorder (PD) and cocaine use. Diagnostic interviews for PD were performed at baseline and 12 weeks (study termination) in 47 cocaine‐dependent individuals entering a pharmacologic treatment trial; 68% met criteria for a PD at baseline, 51% at study termination. In comparing baseline and termination PD, 22 individuals had no change in the number of PDs, 6 had more, and 17 had fewer. The group with an increase in the number of PD diagnoses had more positive urine drug screens than either of the other groups and more cocaine use by self‐report. Personality disorders appear to be common in cocaine‐dependent individuals but may be affected by cocaine use and withdrawal.
Use of the Internet for Addiction Education
Authors: Galanter Marc , Keller Daniel S. , Dermatis Helen , Biderman David
Published: February 2010

The authors prepared a course in addiction psychiatry for the Internet that combines a psychosocial and a medication modality for alcoholism; namely, network therapy and naltrexone. Responses of those who accessed the course revealed 679 counts (visits) at the Web Site. A group of 210 unique respondents, of whom 154 were psychiatrists, answered a demographic question set. Over half of these psychiatrists completed the course and evaluated it. The majority indicated that it helped them understand “a good deal” about the management of alcoholism and the use of network therapy and naltrexone. This result suggests the feasibility of using the Internet as a vehicle for teaching in addiction psychiatry, an area where needs for training are often unmet.
The Minnesota Substance Abuse Problems Scale
Authors: Westermeyer Joseph , Crosby Ross , Nugent Sean
Published: February 2010

The authors determined interrelationships among 61 items in a scale designed to assess the severity of substance‐related disorder (SRD) and develop subscales that measure distinct substance‐related areas of dysfunction. They evaluated 642 outpatients with items previously developed among patients with SRDs. Trained interviewers administered the Minnesota Substance Abuse Problem Scales (M‐SAPS), which uses responses to yes/no (lifetime) questions. A factor analysis of items was compared with data from patients and addiction psychiatrists to measure the concurrent validity of the M‐SAPS factors, yielding 37 items in three factors: Psychiatric‐Behavioral Problems (14 items), Social‐Interpersonal Problems (11 items), and Addiction‐Dependence Symptoms (12 items). These three scales correlate with 10 scales/assessments concurrently collected independently of the M‐SAPS, yielding a brief, valid, interviewer‐administered, substance‐related problem scale that assesses SRD severity in three distinct areas.
Treatment Needs and Initial Outcomes of a Residential Recovery Program for African‐American Women and their Children
Authors: Uziel‐Miller Nina D. , Lyons John S. , Kissiel Cassandra , Love Sharon
Published: February 2010

The current research was designed to assess the treatment needs of 42 substance‐abusing women and the efficacy of a women‐based, culturally influenced, multifaceted residential treatment program for women and their children. Women presented with multidimensional treatment needs, including limited educational/employment histories, significant child‐care needs, and histories of victimization and psychological distress. Women remained in residence for an average of 259 days. In all, 88% of the women remained substance‐free at discharge; 49% had jobs or were enrolled in school/job training. This integrated, gender/culture‐based approach provides a model for more effective substance‐abuse treatment for women and their families.
Substance Use Disorders in Gay/Bisexual Men With HIV and AIDS
Authors: Ferrando Stephen , Goggin Kathy , Sewell Margaret , Evans Susan , Fishman Baruch , Rabkin Judith
Published: February 2010

The authors conducted a longitudinal study of psychological adaptation to AIDS in subjects with and without lifetime and current substance use disorders (SUD), in a cohort of HIV+ gay/bisexual subjects. A sample of HIV+ gay/bisexual men (n = 183) and an HIV‐ comparison group (n = 84) were assessed for SUD, depression, and anxiety disorders. Among HIV+ men, combined lifetime (42%) but not current (11.5%) SUDs were more prevalent than in HIV‐ men (27% and 10%, respectively). HIV+ men with current SUD reported more depression, distress, and diminished quality of life than HIV+ men with no SUD, but HIV‐illness severity did not differ. HIV+ men in recovery did not differ from men with no lifetime history. Most HIV+ gay/bisexual men with SUD discontinue or reduce substance use before or subsequent to knowledge of their HIV infection, probably in an attempt to adopt a healthier lifestyle. However, for some HIV+ men, persistent substance abuse/dependence is accompanied by higher levels of distress and diminished quality of life, underscoring their need for treatment intervention.
The Role of Multifamily Therapy in Promoting Retention in Treatment of Alcohol and Cocaine Dependence
Authors: Conner Kenneth R. , Shea Robert R. , McDermott Michael P. , Grolling Robert , Tocco Robert V. , Baciewicz Gloria
Published: February 2010

The authors present a model for incorporating multifamily therapy in the treatment of chemical dependency and investigate the association of family participation in multifamily therapy group with treatment retention in a sample of 164 alcohol‐ and/or cocaine‐dependent outpatients. Results indicate that level of family attendance at a multifamily group strongly predicted completion of short‐term and long‐term outpatient treatment. Effects were greater for cocaine‐dependent than for alcohol‐dependent subjects in analyses of short‐term treatment retention. Multifamily therapy may be a powerful method to engage patients' families in treatment and promote treatment retention, especially in the early, intensive phases of treatment for cocaine dependency.
Psychiatric Hospital Outcomes of Dual Diagnosis Patients Under Managed Care
Authors: Leon Scott C. , Lyons John S. , Christopher Nina J. , Miller Sheldon I.
Published: February 2010

The authors compared patterns of psychiatric hospitalization utilization and outcomes between persons with and without co‐existing substance‐related disorders in a managed care environment by means of a prospective follow‐along study of persons hospitalized for psychiatric reasons under the auspices of a large regional managed care firm. Forty‐two psychiatric inpatients with comorbid substance disorders and 121 inpatients without coexisting substance disorders were compared across measures of service use and psychiatric acuity. Readmission to the hospital was assessed at 30 days and after 6 months. Patients with coexisting substance disorders spent fewer days in the hospital, but were rehospitalized at a higher rate both within 30 days and (significantly) after 6 months. These results suggest that the revolving‐door pattern of service utilization is also present in managed care environments.
Reliability and Clinical Utility of DSM‐IV Substance‐Induced Psychiatric Disorders in Acute Psychiatric Inpatients
Authors: Ries Richard K. , Demirsoy Alpay , Russo Joan E. , Barrett Joseph , Roy‐Byrne Peter P.
Published: February 2010

The goal of this study was to evaluate in 1,951 acute psychiatric inpatients the reliability, construct, convergent, and predictive validity of substance‐induced psychiatric syndrome ratings made by clinical attending psychiatrists. The primary admitting condition for each subject was categorically rated by clinical attendings as not, mildly, moderately, or mostly substance‐induced at both admission and discharge. Individual substance categories were associated with characteristic demographic, clinical treatment response, and length of stay, findings indicating good construct, predictive validity, and clinical utility. A linear dimensional approach to rating substance‐induced syndromes in acute clinical populations may be preferable to the simple dichotomous approach used in DSM‐IV.
Screening for Drug and Alcohol Abuse Among Older Adults Using a Modified Version of the CAGE
Authors: Hinkin Charles H. , Castellon Steven A. , Dickson‐Fuhrman Elizabeth , Daum Garrett , Jaffe Jerome , Jarvik Lissy
Published: February 2010

This study examined the sensitivity, specificity, and receiver operating characteristics (ROC) curves of a modified version of the CAGE, a screening measure used in the detection of older alcohol‐ and drug‐abusing individuals. In a retrospective review of clinical records of 976 patients screened by a geriatric substance abuse program, the authors examined patients'responses on a modified version of the CAGE that included queries regarding drug use. The CAGE was administered to individuals age 50 or over drawn from three diagnostic groups: alcohol abuse/dependence, drug abuse/dependence, and normal controls. Analysis of variance and discriminant function analyses revealed that the modified CAGE was able to discriminate both alcohol and drug abusers from controls. Analyses examining test sensitivity, specificity, and ROC curves revealed the CAGE to demonstrate excellent sensitivity but poor specificity. Omitting the “cut down” item from the CAGE significantly improved specificity with only a modest drop in sensitivity. Given the ease of administration and sensitivity to both alcohol and drug abuse, these data suggest that the modified CAGE is well suited as a screening instrument for geriatric drug and alcohol abuse.
Motivational Interviewing to Enhance Treatment Initiation in Substance Abusers: An Effectiveness Study
Authors: Carroll Kathleen M. , Libby Bryce , Sheehan Joseph , Hyland Nancy
Published: February 2010

Sixty individuals referred for a substance abuse evaluation by a child welfare worker were randomly assigned to either a standard evaluation or an evaluation enhanced by Motivational Interviewing techniques, each delivered in a single session. Participants who received the enhanced evaluation were significantly more likely to attend at least one additional treatment session after the initial evaluation (59% versus 29%). This finding suggests that comparatively inexpensive modifications of “standard” initial evaluations with substance‐using parents may increase engagement of substance‐abusing parents in treatment. Moreover, this study adds to an overwhelmingly positive literature supporting Motivational Interviewing with alcohol‐using populations and extends prior findings to non‐research community settings.
Predictive Validity of the ASAM Patient Placement Criteria for Naturalistically Matched vs. Mismatched Alcoholism Patients
Authors: Magura Stephen , Staines Graham , Kosanke Nicole , Rosenblum Andrew , Foote Jeffrey , DeLuca Alexander , Bali Priti
Published: February 2010

This study examined the predictive validity of the ASAM Patient Placement Criteria for matching alcoholism patients to recommended levels of care. A cohort of 248 patients newly admitted to inpatient rehabilitation, intensive outpatient, or regular outpatient care was evaluated using both a computerized algorithm and a clinical evaluation protocol to determine whether they were naturalistically matched or mismatched to care. Outcomes were assessed three months after intake. One common type of undertreatment (ie, receiving regular outpatient care when intensive outpatient care was recommended) predicted poorer drinking out comes. As compared with matched treatment, independent of actual level of care received. Overtreatment did not improve outcomes. There also was a trend for better outcomes with residential vs. intensive outpatient treatment, independent of matching. Results were robust for both methods of assessment. Corroboration by more research is needed, but the ASAM Criteria show promise for reducing both detrimental undertreatment and cost‐inefficient overtreatment.
Relationship between Platelet Serotonin Uptake Sites and Measures of Impulsivity, Aggression, and Craving among African‐American Cocaine Abusers
Authors: Patkar Ashwin A. , Gottheil Edward , Berrettini Wade H. , Hill Kevin P. , Thornton Charles C. , Weinstein Stephen P.
Published: February 2010

We investigated whether platelet‐tritiated paroxetine binding, a measure of serotonin uptake sites, and behavioral measures of impulsivity, aggression, and craving differed between cocaine‐dependent subjects and controls and whether paroxetine binding was related to these behavioral measures. One hundred and five African‐American cocaine‐dependent out‐patients and 44 African‐American controls were studied. Tritiated paroxetine binding sites on platelets were assayed, and standardized assessments of impulsivity, aggression, and craving were performed. The Bmax values of paroxetine binding were significantly reduced among cocaine patients compared to controls. Cocaine patients showed significantly higher scores on certain measures of sensation seeking, impulsivity, and aggression as compared to controls. Furthermore, paroxetine binding showed a significant negative correlation with most measures of sensation seeking, impulsivity, and aggression—though not craving—among cocaine patients. Our findings indicate that densities of serotonin uptake sites may be reduced among cocaine abusers and related to impulsive‐aggressive behavioral dimensions.
The MICA Case Conference Program at Tewksbury Hospital, Mass.: An Integrated Treatment Model
Authors: Clodfelter Reynolds C. , Albanese Mark J. , Baker Gregg , Domoto Katherine , Gui Amy L. , Khantzian Edward J.
Published: February 2010

This report describes the MICA (Mentally Ill Chemically Abusing) Program at the Tewksbury Hospital campus in Tewksbury, Massachusetts. Several campus facilities collaborate in the MICA Program. Through Expert Case Conferences, principles of integrated psychosocial treatment with dual diagnosis patients are demonstrated. An expert clinician focuses on the interplay between psychological pain, characterological traits, defenses, and the patient's drug of choice. Patients who have participated in the program have reported positive experiences. The staff reported that the program has resulted in facility improvement in assessment and treatment of complex dual diagnosis patients.
The Role of Psychosocial Treatments in Pharmacotherapy for Alcoholism
Authors: McCaul Mary E. , Petry Nancy M.
Published: February 2010

Medication treatment for alcohol use disorders often includes a psychotherapy component. The most appropriate psychotherapy to use may depend upon characteristics of the patient, the medication, the setting, and the experiences of the provider. To date, little empirical research has investigated these issues with respect to outcomes in clinical trials that combine pharmacotherapy and psychotherapy. This paper reviews seven major types of psychotherapy for treatment of alcohol use disorders: brief interventions, motivational enhancement therapy, cognitive‐behavioral therapy, cue exposure therapy, behavioral treatments, behavioral marital therapy, and twelve‐step therapy. The theoretical basis for and empirical evidence supporting the efficacy of the therapies are reviewed, with an emphasis on studies that provided pharmacotherapy in conjunction with psychotherapy. Directions for future research in this area are also suggested.
Current Pharmacotherapies of Alcoholism: A U.S. Perspective
Authors: Anton Raymond F. , Swift Robert M.
Published: February 2010

Advances in the neurobiology of addiction and improved clinical trial methodology have accelerated the evaluation of medication for alcoholism. While psychosocial interventions have been useful to reduce consumption and support abstinence, considerable improvement in treatment is needed. Medication can play a crucial role in the reduction of craving and drinking and the maintenance of abstinence. This article reviews pharmacotherapy for alcoholism with an emphasis on the perspective of the United States. The opiate antagonist naltrexone, the glutamate modulator acamprosate, and serotonergic agents will be highlighted in this review. In general, both naltrexone and acamprosate have been found in a number of studies to be efficacious agents for the treatment of alcohol dependence. Serotonin reuptake inhibitors have not consistently shown to be efficacious but may be useful in certain subgroups of alcoholics. The serotonin type‐3 antagonist, ondansetron, has shown promise in early‐onset alcoholics but needs more extensive study.
Use of Acamprosate and Opioid Antagonists in the Treatment of Alcohol Dependence: A European Perspective
Authors: Soyka Michael , Chick Jonathan
Published: February 2010

In thirteen of sixteen placebo‐controlled trials in Europe, acamprosate increased abstinence in detoxified alcohol‐dependent patients. It is approved in most EU countries. Its action at N‐methyl‐D‐aspartate (NMDA) receptors appears to account for many of its effects. The number needed to treat in the fifteen trials suitable for meta‐analysis has been calculated at 8.15. Trials of naltrexone in Europe have shown less clear evidence of efficacy than trials of acamprosate, whether abstinence or relapse to heavy drinking is used as the outcome criterion. With reduction in heavy drinking days as the criterion, naltrexone compared favorably to acamprosate in an open study in moderate alcohol dependence; one double‐blind study has pointed to an advantage of the combination of naltrexone with acamprosate over either drug. To date, there are no trials published of nalmefene in European clinics. While many centers routinely offer a trial of acamprosate to newly detoxified patients aiming for abstinence, naltrexone usage varies. Some centers suggest naltrexone not only for patients aiming for abstinence but also for patients for whom continued drinking is a therapeutic possibility or a clinical inevitability.
Stress and Relapse to Drug Seeking: Studies in Laboratory Animals Shed Light on Mechanisms and Sources of Long‐Term Vulnerability
Authors: Stewart Jane
Published: February 2010

Relapse is a major characteristic of drug addiction disorders and remains the primary problem for treatment. Recently, there has been hope that these disorders may be amenable to pharmacological treatments that have successfully treated other psychopathological disorders. Pharmacological approaches to drug abuse have tended to be guided by the primary drug used by the individual, though substitution has been the guiding principle in some instances, as in the case of methadone maintenance in opioid addiction. Alternatively, blockade or antagonism of the effects of the primary drug being abused has been tried, as in the case of using naltrexone to treat opioid or alcohol addiction. Though reportedly successful in some populations, it is not clear that these approaches effectively control craving for ‘highs’ or euphoric experiences or a return to drug use as a response to stressful life experiences. Recent experimental studies of the factors that induce craving and relapse to drug use in both humans and laboratory animals, such as drug‐related cues, re‐exposure to the drug itself, or exposure to stressful events, have shown that the effects of these different events are mediated by dissociable neurochemical circuitry. Another finding that emerges from these studies is that the motivation underlying drug seeking induced by events that precipitate relapse is intensified by the duration and amount of pre‐exposure to a drug and the passage of time since withdrawal of the drug. One implication of such findings for the treatment of addiction is that whatever approach is taken, treatment will have to be multifaceted and maintained over an extended period of time after the initial termination of drug use.
Acupuncture and Substance Abuse: A Synopsis, with Indications for Further Research
Authors: Otto Katharine C.
Published: February 2010

Alcoholism and drug addiction are rampant in our society. Although current treatment works better than nothing, the search for more effective interventions continues. Incorporating acupuncture into existing programs offers a promising approach. Proponents say ear acupuncture alleviates acute opiate withdrawal, reduces craving for all substances, and helps retain patients in treatment. Over 25 years of clinical experience has supported this claim, but scientific research has been sketchy, complicated by technical difficulties and often poorly designed. This article reviews the literature and offers a neurochemical model for future research.
Somatization, Anxiety and Depression in a Drug‐Free Residential Therapeutic Community
Authors: Metrikin Aaron S. , Galanter Marc , Dermatis Helen , Bunt Gregory
Published: February 2010

This study aims to assess the nature and prevalence of somatization and related psychiatric symptoms among residents in Daytop Village, a drug‐free residential therapeutic community (TC). Three hundred and twenty two residents at Daytop were surveyed, and when compared with a normal, non‐patient reference group, residents at Daytop exhibited higher levels of somatization, depression, and anxiety as measured with the Brief Symptom Inventory. Multiple linear regression analysis showed that being widowed or divorced, having marijuana/hallucinogens as greatest drug problem, and the importance of a religious figure in entering Daytop were associated with higher levels of somatization. A length of stay of 3–6 months and acceptance of Daytop program philosophy was inversely correlated with somatization scores. These findings are discussed with particular attention focused on the role of somatization among TC residents.
Predictors of Recovery Following Involuntary Hospitalization of Violent Substance Abuse Patients
Authors: André Charles , Jaber‐Filho Jorge A. , Carvalho Marcelo , Jullien Carlos , Hoffman Ângela
Published: February 2010

The goal of this study was to evaluate the results and predictors of good recovery following involuntary hospitalization of violent substance abuse patients. Twenty patients (16 male, aged 13 to 53 years [mean ± s.d. = 32.9 ± 10.2]) were admitted in 1997 with a median hospital time of 73.5 days (20 to 455) for exhibiting violent behavior following drug abuse and a loss of self‐control. They were treated with psychiatric medication, a 12‐step program (Minnesota), psychotherapy and family therapy, and, following hospitalization, counselling, psychotherapy, and participation in self‐help groups. Follow‐up ranged from 3 to 24 months (17.8 ± 4.9). We studied the probability of maintenance of complete abstinence and social adaptation (professional‐educational, family and legal parameters) using T and Fisher tests (significance level p ≤ 0.05). Of the twenty, thirteen patients (65%) achieved excellent social reintegration, and twelve maintained total abstinence. Two patients died (AIDS, hepatic cirrhosis). The chances of complete abstinence and social reintegration were increased by lower age at admission (p = 0.02), some form of treatment following hospitalization (p = 0.007), adherence to the entire period of treatment (p = 0.05), and regular attendance at self‐help groups (p = 0.05). No significant differences were found in terms of other demographic parameters, drugs used (number or class), previous hospital admissions, length of hospitalization, or follow‐up. Sixty percent of patients can expect an excellent outcome over a period of 18 months, according to strict clinical and social criteria. Early intervention and factors increasing adherence to prolonged treatment increase abstinence and social reintegration and thus should be further explored.
Engaging Young Probation‐referred Marijuana‐abusing Individuals in Treatment: A Pilot Trial
Authors: Sinha Rajita , Easton Caroline , Renee‐Aubin Lisa , Carroll Kathleen M.
Published: February 2010

Young marijuana abusers rarely seek treatment themselves and are difficult to engage in treatment when referred by social agencies. To evaluate treatment engagement strategies in this population, 65 young probation‐referred marijuana abusers were randomly assigned to either three‐session motivational enhancement therapy (MET alone) or three‐session MET plus contingency management (MET/CM), with vouchers for treatment attendance. A significantly higher number of participants in the MET/CM condition completed the three‐session intervention as compared with MET alone. Participants in both conditions reported significant reductions in marijuana use and improvement in legal problems. These findings suggest that young marijuana abusers benefit from scientifically validated treatments.
Patient Attitudes toward Treatment Predict Attendance in Clinical Pharmacotherapy Trials of Alcohol and Drug Treatment
Authors: Pettinati Helen M. , Monterosso John , Lipkin Craig , Volpicelli Joseph R.
Published: February 2010

This study evaluated for 152 patients the relationship between their attitudes toward treatment and session attendance in pharmacotherapy research trials aimed at treating alcohol dependence. The study included a new, 50‐item, patient‐administered measure of attitudes, Treatment Research Experiences and Attitudes Task (TREAT), which is comprised often items from each of five attitudinal dimensions typically associated with treatment adherence: treatment setting, taking medication, social support, medical professional, and intrinsic patient factors. Patients attending 80% or more clinical sessions scored higher, i.e., were more favorable on four of five of attitudinal dimensions. Thus, patient attitudes toward treatment may be useful in identifying areas that limit or improve treatment attendance.
Research Findings on Psychotherapy of Addictive Disorders
Authors: Woody George E.
Published: February 2010

Psychoanalytically trained physicians working in methadone programs in the 1980s theorized that adding psychotherapy to addiction treatment would improve outcomes. Since then, a number of clinical studies have evaluated the effect of psychotherapy, drug counseling, and twelve‐step intervention on treatment outcomes in methadone maintenance or cocaine and alcohol addiction programs. These studies have shown consistently that psychosocial treatments are helpful for patients with addictive disorders, with an effect size that ranges from mild to moderate. Major studies of psychotherapy in the treatment of addictive disorders are reviewed, and background information on psychotherapy and drug counseling is presented.
Steroid and Nutritional Supplement Use in Professional Athletes
Authors: Millman Robert B. , Ross Emil J.
Published: February 2010

The use of performance‐enhancing substances by athletes is nearly as old as sport itself. There are two primary categories of substances available to modern athletes: anabolic androgenic steroids (AAS) and nutritional supplements. All AAS and many of the nutritional supplements are used to increase testosterone levels in the body, thereby enhancing the athlete's ability to build lean muscle mass. Other nutritional supplements are used to increase the amount of energy available for workouts or competition. Although steroids are available in the U.S. via physician prescription, nutritional supplements are widely available to all consumers with relatively scant regulation. Steroids are associated with a variety of side effects that can lead to physical changes, psychological disturbances, morbidity, and even mortality. The side effects of nutritional supplements are not as well studied but are presumed to be similarly dangerous. However, for many athletes at all levels facing pressure to excel, the potential benefits of taking these substances appear to be outweighing the associated risks. Increased testing at all levels is recommended.
Comparison of Desipramine or Carbamazepine to Placebo for Crack Cocaine‐Dependent Patients
Authors: Campbell Jan , Nickel Elizabeth J. , Penick Elizabeth C. , Wallace Dennis , Gabrielli William F. , Rowe Carolyn , Liskow Barry , Powell Barbara J. , Thomas H. Mikel
Published: February 2010

The authors compared the effects of desipramine or carbamazepine to placebo in an intensive outpatient program for cocaine abuse. Subjects recruited from an urban drug treatment program were randomly assigned to a double‐blind, placebo‐controlled, eight‐week trial of desipramine, carbamazepine, or placebo. Patient ratings, urine drug screens, and blood samples were obtained weekly. Using survival analysis, the three groups did not differ in time to drop out of treatment. While subjects improved over time on all self‐ratings related to cocaine use, mood, and craving, only two items related to mood were significantly different over time as a function of treatment group. Subjects in the two treated groups reported significantly more improvement on self‐ratings of depression and irritability. No treatment differences were noted for sustained abstinence or for proportion of positive urine drug screens. Desipr amine subjects who attained a minimum blood level were retained in treatment significantly longer than placebo or other non‐compliant treatment groups. This finding supports previous reports of a possible role for desipramine in cocaine abuse treatment.
Compliance to Supervised Disulfiram Therapy: A Comparison of Voluntary and Court‐Ordered Patients
Authors: Martin Brandon , Clapp Loraine , Bialkowski Diana , Bridgeford Denise , Amponsah Akwasi , Lyons Levester , Beresford Thomas P.
Published: February 2010

We hypothesized that court mandate would significantly enhance compliance with supervised disulfiram therapy. We conducted a twelve‐week prospective study of outpatient compliance with court‐ordered, monitored disulfiram treatment as compared to voluntary, monitored treatment. The court ordered group (n = 19) was significantly more compliant than the voluntary group (n = 22). Legally mandated subjects attended an average of 87% (±21%) of scheduled visits, versus 42% (±35%) for the group without court order. Court mandate roughly doubles the compliance rate of monitored disulfiram therapy, effectively enhancing clinic attendance during the first twelve weeks of treatment.
Psychiatric Disorders and Cigarette Smoking Among Child and Adolescent Psychiatry Inpatients
Authors: Upadhyaya Himanshu P. , Brady Kathleen T. , Wharton Mollie , Liao Jason
Published: February 2010

We surveyed 120 patients admitted to a child and adolescent psychiatric inpatient unit regarding their cigarette smoking history, reasons for smoking, patterns of use, and psychiatric comorbidity (chart review). We administered the Social Phobia and Anxiety Inventory and the modified Fagerstrom Tolerance Questionnaire. Only six of 47 current smokers had a chart diagnosis of nicotine dependence. Logistic regression derived that the odds ratio for being a current smoker was: Caucasian race = 5.56, older age = 1.3, depressive disorders = 4.02, conduct disorder (CD) = 12.96, cannabis abuse/dependence = 24.6. Hence, cigarette smoking is highly prevalent but underdiagnosed in this population.
State Policy and Practice Regarding Substance Abuse Treatment Services for Medicaid Recipients with Disabilities
Authors: Bachman Sara S. , Drainoni Mari‐Lynn , Tobias Carol
Published: February 2010

This article presents the results of an exploratory study conducted to identify best practice Medicaid managed care models for people with disabilities who need substance abuse treatment services. These results suggest that there is wide variation in the managed care strategies that states use to provide substance abuse treatment services to the SSI disabled population, that state policymakers are often focused on general program management issues rather than addressing specific issues related to providing substance abuse treatment services to people with disabilities, and that although managed care theoretically offers opportunities for creativity, this practice does not appear to be widespread under current Medicaid managed care arrangements for people with disabilities.
Demographic and Practice Characteristics of Psychiatrists who Primarily Treat Patients with Substance Use Disorders
Authors: Montoya Ivan D. , Herbeck Diane M. , Svikis Dace S. , Fitek Diana J. , Marcus Steven C. , Pincus Harold A.
Published: February 2010

This study examined the sociodemographic and practice characteristics of psychiatrists whose caseloads consist primarily of patients with Substance Use Disorders (SUD). A survey instrument was completed by a random sample of 865 psychiatrists. Study groups were defined as high‐SUD providers if psychiatrists reported having 51% or more patients with SUD (n = 92) and non‐SUD providers as those who reported not having any patients with SUD (n = 128). High‐SUD providers tended to be younger, more likely to graduate from international medical schools, have larger caseloads, work more hours per week, and have a higher proportion of inpatients and publicly funded patients than non‐SUD providers. Results suggest that psychiatrists who primarily treat patients with SUD are in their early careers and treat patients with more clinical, psychosocial, and economic disadvantages. The implications of these findings for psychiatry training programs and policy makers will be discussed.
Health‐related Quality of Life for Adults Participating in Outpatient Substance Abuse Treatment
Authors: Morgan Thomas J. , Morgenstern Jon , Blanchard Kimberly A. , Labouvie Erich , Bux Donald A.
Published: February 2010

Interest exists in assessing health‐related quality of life as one aspect of treatment effectiveness with substance abuse clients. The SF‐36 Health Survey is a self‐report measure assessing subjective health status along physical and mental health dimensions. Subjects were 252 adults in an outpatient, randomized clinical trial for substance abuse treatment. Subjects reported significantly more impairments in functioning when compared to U.S. population norms, but differences disappeared after three months of treatment. There was little support that quality of life functioning was significantly related to substance use during treatment. Results highlight the importance of using the SF‐36 to facilitate treatment planning.
Gender Differences in Drug Use Behavior in People with Serious Mental Illnesses
Authors: Gearon Jean S. , Nidecker Melissa , Bellack Alan , Bennett Melanie
Published: February 2010

The gender‐specific aspects of drug use in women with serious mental illness (SMI) remains under‐investigated. To improve our understanding of substance use in this population, gender differences in how drugs are initially accessed, how habits are financed and maintained, and reasons for drug use were examined in 28 women and 24 men with SMI. Women were found more likely than men to report being victimized, having drugs given to them by significant others, using money given to them by family members to support their habits, and using drugs to test their ability to control their use.
Disulfiram Treatment for Alcoholism in Severe Mental Illness
Authors: Mueser Kim T. , Noordsy Douglas L. , Fox Lindy , Wolfe Rosemarie
Published: February 2010

Controlled research has shown that supervised disulfiram is an effective treatment for alcoholism. Despite this, little is known about the effects of disulfiram in persons with alcoholism and severe mental illness. We conducted comprehensive chart reviews on 33 patients with alcoholism and severe mental illness (70% schizophrenia or schizoaffective disorder) who had been prescribed disulfiram. Twenty‐one percent reported side effects from disulfiram, whereas significant psychiatric complications were not reported. Although 76%% of patients reported drinking while on disulfiram, only 28%o experienced negative reactions to alcohol. Sixty‐four percent of the patients saw a remission of alcoholism for at least one year during a three‐year follow‐up, and 30%o experienced a two‐year remission. Disulfiram treatment was associated with decreases in days hospitalized but not with changes in work status. The results suggest disulfiram may be a useful adjunctive treatment for alcoholism in patients with severe mental illness and that controlled research is needed to evaluate its effects in this population.
Legal Implications Regarding Self‐Neglecting Community‐Dwelling Adults: A Practical Approach for the Community Nurse in Ireland
Authors: Ballard Julianne
Published: February 2010

ABSTRACT
This paper explores the current literature related to legal issues encountered by the public health nurse in Ireland in visiting clients exhibiting self‐neglecting behavior. Nurses working in community settings where home visiting of clients is required will at some point encounter situations of client self‐neglect. Possession of a clear legal framework for the local area that addresses both the nurse's professional responsibility and the client's rights is needed. Because a high incidence of depression and dementia seen in self‐neglecting adults has prompted calls for wider screening of the agreeable client, an understanding of the definition of competence and capacity in the national legal system for that client becomes critical. In Ireland, as in many other countries, refusal of care or screening is the right of any competent adult. However, issues of mandatory reporting, confidentiality, and trespass may differ from other areas. Nursing care delivered at the community level to a client exhibiting self‐neglecting behavior involves a delicate balance of trust and support. Through this overview of the legal implications for self‐neglecting clients in Ireland, nurses have the opportunity to begin an exploration of similarities and differences in approach on a global level.
A Baseline Evaluation of Casino Air Quality After Enactment of Nevada's Clean Indoor Air Act
Authors: York Nancy L. , Lee Kiyoung
Published: February 2010

ABSTRACT
Objective: The U.S. Surgeon General reports that there is no safe level of exposure to secondhand smoke (SHS). The purpose of this study was to measure levels of fine particulate matter in nonsmoking casino restaurants after enactment of Nevada's Clean Indoor Air Act (NCIAA).

Methods: Fine particulate matter <2.5 μm in diameter (PM2.5) concentrations were measured in 16 casino hotel restaurants and gaming areas for a total of 32 venues. A battery‐operated SidePak aerosol monitor was discreetly used for at least 30 min in each venue.

Results: Nonsmoking restaurant PM2.5 levels ranged from 5 to 101 μg/m3 (M=31; SD=22.9) while gaming areas ranged from 20 to 73 μg/m3 (M=48; SD=15.9). There was a significant difference in PM2.5 between restaurants and gaming areas, t(30)=−2.54, p=.017. There was also a strong correlation between the levels of restaurant PM2.5 and gaming area PM2.5 (r=.71; p=.005).

Conclusion: Fine PM2.5 in all casino areas was above what the Environmental Protection Agency recommends as healthy. This information can be used to educate policy decision makers when discussing potential strengthening of the law.