Health status of employed and unemployed methadone patients.
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Adult↗
Biomedical subjects
J J Platt
Publications and source records attributed to J J Platt.
Schedule of voucher delivery influences initiation of cocaine abstinence.
This study examined whether voucher delivery arrangements affect treatment outcome. First, 90 cocaine-dependent adults were randomly assigned to behavioral counseling or counseling plus vouchers for cocaine-free urine samples. The value of each voucher was low at the beginning but increased as the patient progressed (Voucher Schedule 1). Voucher Schedule 1 produced no improvements relative to counseling only. Next, 23 patients received vouchers on either Voucher Schedule 1 or Voucher Schedule 2. Voucher Schedule 2 began with high voucher values, but requirements for earning vouchers increased as the patient progressed. Average durations of cocaine abstinence were 6.9 weeks on Voucher Schedule 2 versus 2.0 weeks on Voucher Schedule 1 (p = .02). This confirms that vouchers can assist in initiating abstinence and that voucher delivery arrangements are critical.
Adult↗
Counselor prompts to increase condom taking during treatment for cocaine dependence.
This study examined whether active prompting would increase the number of free condoms taken from dispensers placed in counselors' offices in a cocaine abuse treatment clinic. Using a combined multiple baseline and reversal design, two teams of counselors were instructed to actively prompt and encourage condom taking during some conditions and to avoid commenting on or encouraging condom use in other conditions. To monitor accuracy of implementing the intervention, counselors completed a checklist for every subject they saw in their office during the day. Overall, the number of condoms taken per visit during prompting conditions was almost six times greater than during baseline conditions. However, implementation declined during the study, and all counselors complained about the intervention. Implications for dispensing free condoms to reduce HIV risk in drug abuse treatment clinics are discussed.
Acquired Immunodeficiency Syndrome↗
Congruence of the MCMI-II and MCMI-III in cocaine dependence.
This study compared the MCMI-II and MCMI-III among 40 urban, poor, cocaine abusers in outpatient treatment. The mean group profiles had strikingly similar relative elevations on the Antisocial, Narcissistic, Aggressive-Sadistic, Alcohol Dependence, and Drug Dependence scales. However, the MCMI-III group profile was significantly lower in magnitude compared with the MCMI-II. Interval and rank-order correlations were moderate to low for most scales, and 90% of participants produced discrepant 2-point codetypes between the 2 tests. These results suggest that clinicians working in substance abuse settings should perhaps adjust MCMI-III profile elevations upward on most scales (particularly on the personality disorder scales) when comparing results to extant normative data and should use caution when referencing MCMI/MCMI-II interpretive manuals for descriptive correlates of MCMI-III scales and codetypes.
Adult↗
Impact of comorbid personality disorders and personality disorder symptoms on outcomes of behavioral treatment for cocaine dependence.
Studies have revealed a significant adverse impact of comorbid personality disorders on treatment tenure and outcome in a variety of psychiatric and substance abuse populations. We investigated whether this negative relationship also exists among 137 urban, poor, cocaine abusers in behaviorally oriented treatment. Axis II diagnoses were generated categorically using the SCID-II as well as dimensionally using numbers of SCID-II symptoms within diagnostic categories. Contrary to expectations, there were no significant differences between subjects with and without various categorical personality disorders on any outcome measures. Categorical Axis II diagnoses were also minimally correlated with drug use severity, depression, and anxiety at intake, indicating that these were not potential coveriates of outcome. However, dimensional analyses of personality symptoms generated from the SCID-II accounted for substantial proportions of variance in treatment outcomes. Implications of these data for Axis II assessment and drug treatment planning are discussed.
Adult↗
Structured interview versus self-report test vantages for the assessment of personality pathology in cocaine dependence.
The study compared structured interview (SCID-II) and self-report test (MCMI-II) vantages for the detection and characterization of personality pathology among 144 urban, poor, cocaine-addicted individuals seeking outpatient treatment. Diagnostic agreement was inadequate for most disorders, and the instruments at best shared only modest common variance. Positive predictive power was poor for all MCMI-II scales, though negative predictive power was good to excellent. This lends support for the use of the MCMI-II as a screening measure to rule out Axis II disorders; however, confirmation of positive diagnoses will require follow-up interview assessment. Future development of self-report personality inventories for substance abusers should focus on controlling for the acute dysphoric effects of drug use and related dysfunction, expanding attention to Cluster B content domains, and incorporating more objective criteria for assessing paranoia and "odd/eccentric" traits.
Adult↗
Assessment of coercive and noncoercive pressures to enter drug abuse treatment.
This paper reports preliminary data derived from a standardized interview scoring procedure for detecting and characterizing coercive and noncoercive pressures to enter substance abuse treatment. Coercive and noncoercive pressures stemming from multiple psychosocial domains are operationalized through recourse to established behavioral principles. Inter-rater reliability for the scoring procedure was exceptional over numerous rater trials. Substantive analyses indicate that, among clients in outpatient cocaine treatment, 'coercion' is operative in multiple psychosocial domains, and that subjects perceive legal pressures as exerting substantially less influence over their decisions to enter treatment than informal psychosocial pressures. Implications for drug treatment planning, legal and ethical issues, and directions for future research are proposed.
Adult↗
Decline in self-reported dysphoria after treatment entry in inner-city cocaine addicts.
This study examined self-reported dysphoria in 82 consecutive admissions to intensive outpatient treatment for cocaine abuse on whom data for the Beck scales for depression, anxiety, and hopelessness were available for intake and 4 subsequent weeks with no more than 1 missing data point. Mean scores on the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) decreased significantly between intake and Week 1, with no further significant changes from Weeks 1-4. Similar drops in the rate of clinically significant BDI and BAI scores also were observed. Scores on the Beck Hopelessness Scale (BHS) showed no significant changes. By Week 4, rates of clinically significant depression, anxiety, and hopelessness were similar (17%, 13%, and 16%, respectively). These findings suggest that assessing depression and anxiety using the BDI and BAI in this population should be postponed for at least 1 week after intake and that intake levels of self-reported mood may be inappropriate baseline measures for evaluating treatment effects.
Adult↗
Changes in HIV risk behavior among injecting drug users: the impact of 21 versus 90 days of methadone detoxification.
OBJECTIVE: To evaluate the hypothesis that long-term methadone detoxification would produce greater HIV risk reduction among injecting drug users (IDU) than short-term detoxification. DESIGN: Random assignment to 21 or 90 days of free detoxification. SETTING: Storefront offices in two cities, with referrals to outpatient methadone detoxification. PARTICIPANTS: Out-of-treatment IDU (n = 1803), recruited through street outreach and word of mouth, between April 1990 and March 1991. Of these, 62.6% were successfully located for 6-month follow-up. MAIN OUTCOME MEASURES: Self-reported drug injection and sexual practices at baseline and follow-up. RESULTS: Substantial reductions in risk behavior were observed at follow-up. Substantial percentages of subjects reported less frequent drug injection (54%), use of shooting galleries (85%), needle-sharing (67%), and number of sex partners (73%), and more frequent use of bleach to disinfect needles (67%) and condom use (31%). There were no significant differences in behavioral change between 21 and 90-day treatment, and subjects who entered treatment did not report significantly greater risk reduction than untreated subjects. Discriminant analyses showed a marginal effect for duration of treatment on risk reduction, although results were inconsistent. CONCLUSIONS: Large scale behavioral risk reduction appears to be occurring in this population regardless of treatment condition. In minimal service methadone detoxification, subjects treated under a longer-term detoxification protocol demonstrated no greater risk reduction than those receiving short-term detoxification.
Analgesics, Opioid↗
Uniform standards for substance user treatment research: an example from Germany for the United States and other countries.
It is only through reasoned, accurate treatment evaluation research that its effectiveness can be assessed. The value of these data can be limited, however, by variability of methods and noncomparability of data. This is not the case, however, in other western countries. Germany has developed and is using a set of research and publication standards which speak to many of these deficiencies. These standards, described here in some detail, can serve as a model for regular, uniform, and universal data collection, thus allowing for some meaningful comparisons and assessments of in-situ treatment and the individuals receiving it.
Germany↗
Prospective evaluation of a model of risk for HIV infection among injecting drug users.
Data on 3016 out-of-treatment injecting drug users (IDUs) were analyzed in order to replicate findings from an earlier study on risk factors for HIV infection (Iguchi et al., 1992) and evaluate a model for estimating probability of infection. Logistic regression analyses yielded a set of risk factors highly consistent with previous findings. A logistic function was used to estimate subjects' probabilities of infection, and these estimates were strongly correlated with actual HIV prevalence in both the original and current samples. The current study represents a successful replication of earlier findings and supports the validity of the risk model.
Adult↗
Vocational rehabilitation of drug abusers.
Employment has been identified as an important element in the rehabilitation of drug abusers and, together with abstinence from illicit drugs and criminal involvement, is frequently used as a criterion of treatment outcome. The research literature for the last 20 years on variables affecting employment and the vocational rehabilitation of drug abusers is reviewed with an emphasis on (a) the identification of variables influencing the employment of drug abusers and (b) the evaluation results of interventions that have been developed for this purpose. It is concluded that a number of programs have been demonstrated to have had some success in the vocational rehabilitation of drug abusers. Specific recommendations are made concerning both the direction of further research in this area and the application of existing knowledge in current practice.
Employment↗
Situations occasioning cocaine use and cocaine abstinence strategies.
We interviewed 265 cocaine-experienced methadone patients about situations that occasioned their cocaine use and strategies they used to avoid cocaine use. Subjects identified an average of 15 situations that occasioned cocaine use. The three most frequently identified were having the drug present (86% of subjects), being offered the drug (85%) and having money available (83%). Subjects reporting fewer situations also reported longer periods of lifetime abstinence (p < 0.01). A principal components analysis extracted 10 groups of situations that were most frequently identified in combination. Subjects identified a median of seven strategies for avoiding cocaine use; however, there was large inter-subject variability. This variance was not accounted for by demographic variables, employment status or treatment experience. The three strategies identified most frequently were avoiding people and places (81%), thinking about what they could lose (76%) and leaving the situation (66%). The total number and type (reactive vs. proactive) of strategies identified by subjects had no relationship to cocaine abstinence, although four specific strategies (thinking about what could be lost, leaving the situation, moving to a new area and using a different drug) were positively correlated with cocaine abstinence. We discuss implications of these results for clinical practice.
Adult↗
Hopelessness in i.v. drug users not in treatment and seeking HIV testing and counselling.
The Beck Hopelessness Scale (BHS) was administered to 2379 intravenous drug users who were not in treatment, unaware of their human-immunodeficiency-virus (HIV) status and seeking HIV testing and counselling. Three BHS principal components were identified reflecting resignation to the futility of changing the future, rejection of the possibility of a hopeful future, and acceptance of the inevitability of a hopeless future. The principal component scores representing these three dimensions were positively related to self-reported depression and suicidal ideation; the rejection scores were positively correlated with confirmed HIV seropositivity.
AIDS Serodiagnosis↗
Barriers to out-of-hospital care for AIDS patients.
Inappropriate delays in hospital discharge for AIDS patients add to the expense of health care, as well as to the stress felt by the patient. It has been postulated that delays are due to a lack of suitable out-of-hospital services and weak patient support networks. The charts of AIDS patients discharged from hospitals in northern New Jersey and southern New Jersey/Philadelphia, PA between 3/88 and 1/90 (n = 601 discharges for 454 patients) were examined to determine the discharge services or goods which were ordered and/or received, the extent of actual delay, and the causes of these delays. While regional variations were evident, differences in the profession of the discharge planner were associated with having care ordered and received and delays in discharge; as were availability of a support system, presence of a case manager, and race. A nurse or a social worker (as compared to a doctor as discharge planner) were more likely to effectively order and arrange out-of-hospital care, and were thus more likely to experience delays in hospital discharge. Failures of physicians to make timely requests for care were also associated with delays. Recommendations for future research were made.
Acquired Immunodeficiency Syndrome↗
Interpreting HIV seroprevalence data from a street-based outreach program.
A total of 4,375 subjects were recruited through continuous street outreach over 31 months for interviews on HIV-related risk behavior and HIV-antibody testing. Changes over time among sampled subjects with respect to HIV infection and HIV-risk behavior have been examined retrospectively, and significant and consistent trends noted across successive cohorts. Although overall 42% of the sample tested HIV antibody-positive, HIV infection exhibited a consistent downward trend from 60% in the first quarter year of interviewing to 22% in the final quarter year. Scores on a multivariate index of HIV risk also declined significantly. Mean age, proportion of Black subjects, mean length of drug injection career, frequency of drug injection, and the use of shooting galleries all declined significantly across quarters as well. We argue that these observed differences result from a systematic sampling bias inherent in our outreach-driven sampling procedures, which initially favored recruitment of IDUs with greater behavioral and demographic risk for HIV.
Adult↗
Participation in an outreach-based coupon distribution program for free methadone detoxification.
OBJECTIVE: The purpose of the study was to identify characteristics of injection-drug users that predicted whether subjects would redeem a coupon for free methadone detoxification and to determine whether they were more likely to participate in a 90-day detoxification program than in a 21-day program. METHODS: A total of 4,390 current heroin users recruited through street-based outreach programs in Newark and Jersey City, New Jersey, accepted coupons for either 21 or 90 days (randomly determined) of methadone detoxification after they were interviewed about drug use and sexual behavior. Subjects also gave blood samples for HIV testing. Multiple regression analysis was used to determine variables associated with coupon redemption. RESULTS: Of 4,390 coupons distributed, 58.5 percent were redeemed; the 90-day coupons were redeemed at a significantly higher rate (59.9 percent) than the 21-day coupons (56.9 percent). Among coupon redeemers, 43.6 percent had never received formal drug treatment, and 44.9 percent were HIV seropositive. Frequent heroin use, previous drug detoxification, frequent drug injection, cleaning needles with bleach, nonblack race, Hispanic ethnicity, and Newark residence each significantly predicted coupon redemption. CONCLUSIONS: Outreach-based coupon distribution may be used to recruit large numbers of never-treated and HIV-infected drug users into treatment. The 90-day coupon was more effective in facilitating treatment entry.
AIDS Serodiagnosis↗
Family therapy for Dutch drug users: the relationship between family functioning and success.
This article reports treatment outcome in families with drug problems after a family therapy intervention. An attempt is made to determine what changes occur in family functioning in the course of treatment with family therapy, and how these changes relate to prolonged abstinence and improvement in social functioning in drug misusers. The results indicate that, overall, most families, one year after the start of family therapy, changed in the predicted direction as determined by an observation instrument. Furthermore, success in treatment for the drug misuser was most likely to occur in families in which the parents communicated with each other in a predominantly negative way at the beginning of therapy, and when, in the course of therapy, a significant change occurred toward a more positive supportive manner of communicating.
Adult↗