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Biomedical subjects

G De Leon

Publications and source records attributed to G De Leon.

At least 37 records · Page 2Linked to original sources
PubMed1997

Motivation and readiness for therapeutic community treatment among cocaine and other drug abusers.

There is currently little empirical research on the effect of motivation and readiness on the treatment of different groups of substance abusers. In the present study, the CMRS scales are used to assess motivation and readiness for treatment of a large sample of primary alcohol, marijuana, heroin, cocaine, and crack cocaine abusers admitted to a long-term residential therapeutic community. Findings show few significant differences in overall retention or initial motivation and readiness. Initial motivation and readiness scores persist as significant predictors of short-term retention in treatment across most groups. Findings support the TC perspective that the substance abuse problem is the person, not the drug of choice, and are consistent with prior research emphasizing the importance of dynamic rather than fixed variables as determinants of retention.

Adult↗
PubMed1997

Modified therapeutic community for mentally ill chemical "abusers": background; influences; program description; preliminary findings.

This paper briefly surveys the literature that addresses the problem of co-occurring mental and "substance abuse disorders." It discusses several convergent influences on the development of modified therapeutic community (TC) approaches. The paper describes in some detail the modified TC program for mentally ill chemical "abusers" (MICAs). The paper also summarizes research data that establish positive retention rates and significant in-treatment change to support the effectiveness of the modified TC and to underscore the limited effect of treatment-as-usual approaches. Treatment approaches must be comprehensive, multidimensional, of relatively long duration, and must systematically address the interrelated problems of mental illness and substance use.

Comorbidity↗
PubMed1995

Therapeutic community methods in methadone maintenance (Passages): an open clinical trial.

A non-random open clinical trial was conducted to determine whether a day-treatment program based on modified therapeutic community (TC) methods (Passages) produced better treatment outcomes for heroin addicts than did standard methadone maintenance therapy. Altogether, 327 methadone clients at two clinic sites were studied: 115 Passages members, and 212 comparison subjects. Compared to non-Passages clients, clients who voluntarily joined and remained in Passages for at least 6 months exhibited significantly larger reductions in cocaine use, heroin use, needle use, criminal activity, and psychological dysfunction. The present findings suggest that TC-oriented enhanced day-treatment can help methadone clients recover from drug abuse and adopt a prosocial lifestyle.

Adult↗
PubMed1995

Comparison of extradural fentanyl, bupivacaine and two fentanyl-bupivacaine mixtures of pain relief after abdominal surgery.

Fentanyl 50 micrograms, bupivacaine 50 mg and two mixtures containing fentanyl 50 micrograms and bupivacaine 25 mg or 12.5 mg (0.25 and 0.125%), respectively, in a volume of 10 ml were administered via thoracic extradural catheters to 24 patients after major abdominal surgery. All patients received all four treatments, in a randomized order, so that each patient received one of the 24 possible combinations of the four treatments. Pain relief was assessed by a linear analogue pain scale and the Prince Henry Hospital pain score. The duration of pain relief, effects on ventilatory frequency, heart rate, arterial pressure and central venous pressure were also recorded. Mean reductions in the analogue pain scale for fentanyl, bupivacaine, and fentanyl in 0.25% and 0.125% bupivacaine were 80 (SEM 5) %, 87 (4) %, 86 (5) % and 77 (5) %, respectively (ns). Pain scores decreased by 62 (6) %, 83 (5) %, 77 (6) % and 72 (6) %, respectively (ns). Mean arterial pressure decreased to 90 (2) %, 70 (2) %, 81 (2) % and 82 (3) %, respectively, of pretreatment values. In this respect, bupivacaine alone was significantly different from the three other treatments (P < 0.001). Hypotension (reduction in arterial pressure greater than 25% of pretreatment mean arterial pressure) was also more frequent after bupivacaine alone (P < 0.01). Effects on ventilation, heart rate and central venous pressure did not differ between the four treatments.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Pain↗
PubMed1995

Therapeutic communities for addictions: a theoretical framework.

Adaptation of therapeutic communities (TCs) for new clients and in different settings has resulted in a diversity of programs with unique treatment protocols and different planned duration of stays. The extent to which the various adaptations retain the essential elements of the TC model is not known, and moreover, casts questions about the general effectiveness of the therapeutic community modality. This paper outlines a theoretical framework of the addiction TC to advance research and guide training, practice, and program development. The essential elements of the TC are organized into four areas: its perspective, treatment approach, program model, and the treatment process. Some implications of a TC theory, model, and method are discussed in terms of research, treatment, and policy issues.

Goals↗
PubMed1994

Some problems with the anti-prohibitionist position on legalization of drugs.

The pro-legal position has mounted cogent arguments to support conclusions that the existing prohibition policy has failed and that legalization, while not a solution to the drug use problem, will effectively eliminate drug related crime. The premise of this article is that a legalization policy is wrong in that the basic assumptions underlying the anti-prohibitionist position are flawed. Prohibition has operated in a social vacuum. It has been an isolated effort substituting for an integrated and well coordinated approach which includes prevention, treatment as well as enforcement and supported by an educated public resolve against illicit drugs.

Attitude to Health↗
PubMed1994

Circumstances, motivation, readiness, and suitability (the CMRS scales): predicting retention in therapeutic community treatment.

Based upon clinical considerations, scales were developed measuring client perceptions across four interrelated domains: circumstances (external pressures), motivation (intrinsic pressures), readiness, and suitability (CMRS) for residential TC treatment. This paper, the first in a series, reports findings on the reliability of the CMRS and its validity as a predictor of retention in TC treatment in three cohorts of consecutive admissions to a long-term residential TC. The main findings show that: (a) discriminant and factor analyses confirm the face validity of the original four rationale scales; (b) scores distribute into four groups, with most clients in the moderately low to moderately high range; (c) two cross-validation studies confirm the internal consistency of the scales, and a linear relationship between the separate and total CMRS scores and short-term retention in all three cohorts and long-term retention in two cohorts. The present psychometric study provides impressive findings on the reliability and validity of the CMRS scales as predictors of retention in long-term TCs. Although still considered experimental, awaiting replicational studies and firm conclusions concerning generalizability, the CMRS holds considerable promise for research, theory, and practice.

Adult↗
PubMed1993

Criminal involvement of cocaine users enrolled in a methadone treatment program.

This was a study of criminal activities of cocaine users versus non-users enrolled in a methadone treatment program in New York City. Of those 140 methadone clients studied, 100 (71%) were cocaine users. There were no demographic differences between the two groups except marital status. Married clients (including common-law married) were more likely than never-married single clients to be non-users. Cocaine users were significantly more depressed, using the subscale of the Symptom Checklist-90. Although numbers of lifetime arrests and criminal involvement (in the year immediately preceding the research interview) of cocaine non-users were distinctively lower than those of users, the differences were not significant. In a multiple regression analysis, length of stay in the methadone program was the strongest predictor of criminal involvement. Those who were retained longer in the treatment were significantly less likely to be involved in criminal activities, regardless of cocaine use.

Adult↗
PubMed1993

A general hospital day program combining peer-led and professional treatment of cocaine abusers.

OBJECTIVE: Cocaine abuse, particularly in crack form, is highly prevalent among patients with severe socioeconomic disadvantages who are treated in municipal general hospitals. The authors describe and evaluate a day treatment program for 30 such patients that combines peer-led self-help and professional care provided by a general hospital psychiatric service. METHODS: Treatment outcomes at one year for 92 patients referred to the day program from the hospital's psychiatric services and 58 perinatal patients referred from the obstetric services were examined using chi square and regression analyses to determine whether certain variables, especially referral source, were related to outcome. An acceptable treatment outcome was defined as three successive negative urinalyses before termination or at the end of one year of treatment. RESULTS: Almost all the patients were unemployed members of ethnic minorities, and most abused at least one substance in addition to cocaine. The 150 patients attended the program an average of 44 times during the year, and 39 percent had an acceptable treatment outcome. Patients referred from psychiatric services had a better outcome than perinatal patients. CONCLUSIONS: Peer-led milieu treatment and professional services can be combined in the general hospital to provide intensive ambulatory care for socioeconomically disadvantaged substance abusers. Techniques and services for engaging perinatal patients in treatment should be developed.

Adult↗
PubMed1993

Correlates of drug injection behaviors among methadone outpatients.

Intravenous drug use, which has been recognized as the second most common risk behavior associated with AIDS, was studied among methadone outpatients who were enrolled in a methadone program at a hospital-based clinic in New York City. Intercorrelations among the following variables were observed: sociodemographic, psychological, drug use patterns, and criminal history. Then a stepwise discriminant analysis was employed to examine factors differentiating the high risk clients from the lower risk clients in terms of needle use/sharing in the 30 days prior to the interview. The subjects (N = 152) were heterosexual (95%), non-White (63%), had no more than 12 years of education (72%), were not full-time employed (65%), and had been arrested at least once (79%). The median age at the time of entering the methadone treatment was 33 and the median length of stay in the treatment was 17.5 months (mean = 44.7 months), with an average 52 mg of methadone dosage. Results indicated that risk behavior in terms of current needle use/sharing occurred in about 16% of a sample of clients in the methadone maintenance. A shorter length of stay in treatment was the strongest predictor of high risk, followed by early arrest history, ethnicity, depression, and employment status.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Crack/cocaine abusers in the general hospital: assessment and initiation of care.

OBJECTIVE: Cocaine, either smoked (as "crack") or taken intranasally, is now a common cause of psychiatric illness. This study was designed to assess the impact of cocaine abuse on a general psychiatric service and an obstetrics service in an urban general hospital and to evaluate a program for engaging affected patients in addiction treatment. METHOD: The charts of 300 general psychiatric patients (not admitted for addiction treatment) and 60 cocaine-abusing prenatal or postpartum patients were reviewed. A treatment referral program based on professionally directed peer leadership was established for patients with cocaine abuse. Results of evaluation and referral of 100 other cocaine-abusing psychiatric patients and the 60 prenatal or postpartum patients were then determined. RESULTS: Fully 64% (N = 191) of the 300 psychiatric patients were diagnosed as substance abusers; 38% (N = 113) of them abused cocaine. Almost one-third of these cocaine abusers had no axis I diagnosis other than substance abuse/dependence, and the majority were homeless. Urine samples were positive for cocaine in a majority of the obstetric patients studied. A majority of the psychiatric patients who were referred through the peer-led program enrolled in outpatient cocaine treatment--three times as many as in the chart review group. Most of the obstetric patients suitable for referral enrolled for treatment as well. CONCLUSIONS: Cocaine abuse may be responsible for a large portion of psychiatric admissions in urban public general hospitals. Cocaine abusers in psychiatric and obstetrics services are apparently responsive to a peer-oriented mode of referral into treatment.

Adult↗