Biomedical subjects

J R McKay

Publications and source records attributed to J R McKay.

At least 37 records · Page 2Linked to original sources

PubMed1999

Continuing care for cocaine dependence: comprehensive 2-year outcomes.

This report presents 2-year outcome data from an outpatient continuing care study in which cocaine-dependent patients (N = 132) were randomly assigned to either standard group counseling (STND) or individualized relapse prevention (RP). Data on cocaine outcomes during the 6-month treatment phase of the study were presented in an earlier report (J. R. McKay, A. I. Alterman, J. S. Cacciola, M. R. Rutherford, & C. P. O'Brien, 1997). In the present report, a continuing care condition main effect was obtained on only 1 of 8 outcome variables examined. However, patients who endorsed a goal of absolute abstinence on entering continuing care had better cocaine use outcomes in RP than in STND, whereas the opposite was the case for those with less stringent abstinence goals. In addition, patients with current cocaine or alcohol dependence on entering continuing care who received RP had better cocaine use outcomes in Months 1-6 and better alcohol use outcomes in Months 13-24 than those in STND.

Adult↗

PubMed1999

Comparability of telephone and In-person structured clinical interview for DSM-III-R (SCID) diagnoses.

The SCID was administered twice, once by telephone and once in person (1 week later) to 41 college age men. For major depression (lifetime k =.64, current k =.66), results indicated good agreement. The lifetime occurrence estimate based on the telephone SCID diagnosis was lower than the in-person SCID estimate. Kappas for specific diagnoses were calculable for simple phobia (lifetime k =. 47, current k = .03) and social phobia (lifetime k =.29). Base rates were less than 10% for all individual diagnoses except lifetime major depression; therefore, the kappas may be unstable. For all diagnoses where there were any positive cases, percentages of negative agreement and specificity were high, whereas percentages of positive agreement and sensitivity were lower. Overall agreement was fair for specific lifetime diagnoses but poor for current diagnoses. These results suggest caution in assuming comparability of in-person and telephone SCID diagnoses. Circumstances under which a telephone SCID may be useful and ways to improve reliability are discussed.

Adjustment Disorders↗

PubMed1999

The 2-year test-retest reliability of the Psychopathy Checklist Revised in methadone patients.

The 2-year test-retest reliability of the Psychopathy Checklist-Revised (PCL-R) was examined in 200 men and 25 women methadone patients. Stability of the PCL-R was generally good whether it was evaluated as a dichotomous or dimensional measure. Utilizing a diagnostic cutoff score of 25 or more the intraclass correlation coefficients (ICCs) were.48 for men and.67 for women. For the Total PCL-R score ICCs were.60 and.65 for men and women, respectively. Factor 1 was more reliably measured in women compared to men (.63 vs.43). For men, Factor 1 was significantly less reliable than Factor 2 or the Total score. For women, Factor 2 was significantly less reliable than the Total PCL-R score or Factor 1.

Adult↗

PubMed1999

The relationship of alcohol use to cocaine relapse in cocaine dependent patients in an aftercare study.

OBJECTIVE: To examine the relationship between alcohol use and cocaine relapse. METHOD: Ninety-eight cocaine-dependent male patients in aftercare were followed for 6 months following completion of an intensive outpatient rehabilitation program (IOP). Past and current alcohol dependence was assessed at entrance into aftercare, and drinking behavior prior to cocaine relapse and "near miss" episodes was assessed at 3- and 6-month follow-ups. Data on cocaine and alcohol use throughout the follow-up were also obtained. RESULTS: Patients who had never met criteria for alcohol dependence and those with current alcohol dependence had worse cocaine outcomes (cocaine use on 10% and 7% of the days in the follow-up, respectively) than those with past alcohol dependence (cocaine use on 3% of the days in the follow-up), although alcohol dependence status no longer predicted cocaine use outcomes when cocaine use in IOP was controlled. Alcohol use in 4 of the first 5 follow-up months significantly predicted cocaine relapse status in the next month after cocaine use in IOP and alcohol dependence diagnosis at baseline were controlled. Patients who experienced cocaine relapses were much more likely to report drinking before the onset of the episode than those who had "near misses," particularly on the day of the episode (40% vs. 6% at 3 months; 62% vs. 0% at 6 months). Alcohol did not appear to be a factor in the relapses of cocaine patients with no history of alcohol dependence, even though they did report drinking on 5% of the days in the follow-up. CONCLUSIONS: Relapse prevention efforts with cocaine abusers who have histories of alcohol dependence should include interventions designed to reduce drinking.

Adult↗

PubMed1999

Studies of factors in relapse to alcohol, drug and nicotine use: a critical review of methodologies and findings.

OBJECTIVE: To critically review the methodologies used to study relapse in substance abusers and compare some of the findings these methodologies have produced. METHOD: Representative studies that have used retrospective, prospective, or near real time methodologies to study antecedents or consequences of relapse are presented and the strengths and weaknesses of each methodology are reviewed. Limitations in the ability of substance abusers to accurately report internal states are considered. Degree of convergence in findings across methodologies is examined. RESULTS: Retrospective reports can provide perhaps the most detailed accounts of circumstances and experiences leading up to relapse, but are also more likely to be inaccurate due to the limitations of memory. Prospective studies are less likely to be affected by memory problems, but may not capture factors that immediately precede relapse. The near real time methodology, which uses palm-top computers to gather data, has many advantages over other methodologies, but a number of limitations as well. The two studies in which retrospective reports were directly compared to either prospective or near real time reports yielded mixed results regarding degree of agreement. Findings from several areas of research suggest that some substance abusers may have difficulty recognizing and reporting internal states. CONCLUSIONS: Despite memory problems and other limitations of self-report, all three methodologies have produced findings that implicate negative affect states, increased craving, cognitive factors, interpersonal problems, and lack of coping as factors in relapse. Future relapse studies should make use of all three methodologies to obtain data on relapse and consequences, and steps should be taken to enhance the accuracy of the self-reports that are gathered with each method.

Alcoholism↗

PubMed1998

Prediction of 7 months methadone maintenance treatment response by four measures of antisociality.

Zero-order correlational and simultaneous regression analyses were performed to ascertain the comparative validity of four measures of antisociality for predicting the initial 7 months treatment response of 193 male methadone maintenance (MM) patients. Predictor variables were the number of childhood conduct disorder (CD) behaviors, number of adult antisocial personality disorder (A-APD) behaviors, the revised Psychopathy Checklist (PCL-R) score and the revised California Psychological Inventory-Socialization (CPI-So) scale score. The outcome measures were completion/noncompletion of 7 months of treatment, percent positive during-treatment of cocaine, opiate and benzodiazepine urine toxicologies, and change from baseline to 7 months follow-up in seven Addiction severity index (ASI) composite scores (CSs). All four measures of antisociality were significantly correlated with treatment noncompletion, although only the PCL-R score was significant in the predictor model. The PCL-R predicted more positive cocaine urines. At the individual level, both PCL-R and CPI-So were associated with more positive benzodiazepine urines, but neither contributed a significant amount of variance when both were entered in the model. None of the predictors were significantly associated with self reported improvement in the CSs. The PCL-R and CPI-So were more successful in predicting outcomes than the two behavior-based measures.

Adult↗

PubMed1998

A typology of antisociality in methadone patients.

Multistage cluster analyses with replications were used to sort score profiles of 252 methadone maintained men on 4 continuous measures of antisociality--childhood conduct disorder and adult antisocial personality disorder symptoms, the revised Psychopathy Checklist, and the Socialization scale of the California Psychological Inventory. The analysis yielded 6 replicable and temporally stable cluster groups varying in degree and pattern of antisociality. The groups were statistically compared on sets of external criterion variables--Addiction Severity Index measures of past and recent substance abuse and functioning and lifetime criminal history. Axis I and II symptomatology, anxiety and depression, object relations and reality testing, hostility, guilt, and machiavellianism. The expression of antisociality in the 6 groups and differences found among them on the external variables supported the validity of a more complex conceptualization of antisociality than is provided by antisocial personality disorder.

Adult↗

PubMed1998

Random versus nonrandom assignment in the evaluation of treatment for cocaine abusers.

Cocaine-abusing patients randomly assigned to day-hospital or inpatient rehabilitation were compared with patients who self-selected these treatment settings to examine differences in substance use and psychosocial outcomes under experimental and nonexperimental designs. There was little evidence of setting or assignment effects or Setting x Assignment interactions over the 12-month follow-up period. However, Assignment x Time interactions were obtained with 2 measures of cocaine use and measures of family-social and psychiatric problem severity. These interactions indicated greater problem severity at intake among the randomized patients coupled with greater improvements by the 3-month follow-up relative to the nonrandomized patients. Findings suggest that randomized studies of treatment for cocaine abuse may produce somewhat larger estimates of improvement than what is observed in more typical treatment situations.

Adult↗

PubMed1998

The early course of change in methadone maintenance.

AIMS: This study examined the functional and substance use status of methadone maintenance (MM) patients at treatment entry and 2 and 7 months later. DESIGN: Two groups of subjects were identified for longitudinal follow-up, those in continuous MM treatment and those who left treatment. SETTING: The study was conducted at the Philadelphia Veterans Affairs Medical Center MM Program. PARTICIPANTS: Subjects were 157 men admitted to treatment. MEASUREMENTS: Change was evaluated using the Addiction Severity Index and urinalysis results. FINDINGS: Both groups of subjects reported significant reductions in drug use and increases in psychosocial functioning from admission to month 2, but demonstrated no significant changes from months 2 to 7. Subjects who left treatment, however, had more heroin use and criminal activity at all evaluation points than subjects who remained in treatment. Urinalysis data also suggested that subjects who left treatment were using drugs more frequently while in treatment than were those subjects who remained continuously enrolled in MM. Finally, subjects who left treatment spent more time in restricted environments (e.g. inpatient treatment, jail) at follow-up. CONCLUSIONS: Services may need to be enhanced to foster continuing progress in patients who remain in MM treatment and to retain those patients with more severe problems who leave treatment early.

Adult↗

PubMed1998

Gender differences in the relationship of antisocial personality disorder criteria to Psychopathy Checklist-Revised scores.

The relationship among adult, child, and full antisocial personality disorder (APD) criteria with the Psychopathy Checklist-Revised (PCL-R) (Hare, 1991) scores, an alternative to the Diagnostic and Statistical Manual of Mental Disorders' APD diagnosis, is examined in 395 men and 121 women substance abusers. Based on prior research, it was hypothesized that the correlations among childhood, adult, and full APD criteria and PCL-R Total, Factor 1 (Psychopathic Personality Traits), and Factor 2 (Antisocial Lifestyle) scores would differ for men and women. There was no difference between men and women in the correlations between full APD and PCL-R scores. Adult APD, however, had a stronger relationship to the Total and Factor 1 PCR-R scores in women compared to men, whereas child APD criteria were significantly related, although weakly, to Factor 1 scores for men, but not for women.

Adult↗

PubMed1998

Long-term test-retest reliability of personality disorder diagnoses in opiate dependent patients.

This investigation reports the two year test-retest reliability of DSM-III-R personality disorder (PD) diagnoses in a sample of 219 patients with opiate dependence admitted to methadone treatment. Different MA/PhD interviewers at each assessment used a semistructured diagnostic interview for PD, the Structured Interview for DSM-III-R Personality Disorders (SIDP-R), to make their diagnoses. The reliability of any PD diagnosis versus no PD was fair (kappa = .51). The reliability for any specific PD (weighted kappa = .31) was poor. Antisocial (kappa = .45) and sadistic (kappa = .42), were the only specific PDs for which at least fair reliability was achieved. At the cluster level, only Cluster B had fair reliability (kappa = .47). The intraclass correlation coefficients between number of criteria for the specific PDs at the two evaluation points were consistently higher (range .22 to .62.) than were the corresponding kappas for categorical diagnoses. In that the base rates for most of the PDs were low and agreement for the specific PDs typically exceeded 90%. Increasing the base rate by lowering the diagnostic threshold, or examining more severe cases by raising the diagnostic threshold, did not consistently effect reliability. Reasons for the low kappa coefficients and the implications for PD research are discussed.

Adult↗

PubMed1998

Predictors of participation in aftercare sessions and self-help groups following completion of intensive outpatient treatment for substance abuse.

OBJECTIVE: The goals of this study were to identify predictors of greater participation in aftercare treatment sessions and self-help groups during the first 3 months following completion of a 4-week intensive outpatient rehabilitation (IOP) program. METHOD: The subjects were 138 male veterans who met DSM-III-R criteria for lifetime diagnoses of both alcohol and cocaine dependence (n = 67), alcohol dependence only (n = 48) or cocaine dependence only (n = 23); completed an IOP program; and expressed a desire to enter a formal aftercare program. Analyses examined relationships between predictor variables from five different domains and number of aftercare sessions and self-help groups attended in the last week of each month of the follow-up period. RESULTS: Of the many potential predictor variables that were examined, only remission from cocaine and alcohol dependence during IOP and higher AIDS risk behavior scores in the prior 6 months contributed independently to the prediction of greater participation in aftercare. Further analyses identified several variables that were differential predictors of participation in individualized relapse prevention aftercare versus standard 12-step focused group aftercare. More years of cocaine use, greater current legal problems and a lack of current alcohol dependence predicted greater self-help participation at the level of a trend. CONCLUSIONS: The achievement of remission from substance use dependence during IOP may be an important criterion for moving to the next level of care. However, the results of the present study also point to the need for an increased focus on factors present during the course of aftercare in future studies of retention in aftercare following outpatient rehabilitation.

Acquired Immunodeficiency Syndrome↗

PubMed1998

Personality pathology and drinking in young men at high and low familial risk for alcoholism.

OBJECTIVE: Three groups varying in familial alcoholism risk were compared with respect to amount of alcohol consumption, presence of personality pathology, and the relationship between personality pathology and alcohol consumption. METHOD: Research subjects were young adult men recruited from local colleges, a trade school and the community. The risk groups included (1) a group with a biological alcoholic father and significant additional familial alcoholism (n = 106); (2) subjects with an alcoholic father, but without significant additional familial alcoholism (n = 100); and (3) a group with no paternal alcoholism and at most only one second/third-degree alcoholic relative (n = 190). Absolute daily ounces of alcohol was determined using a standard quantity-frequency scale. Prevalence of DSM-III-R personality disorders (PDs) was evaluated using the Personality Disorder Questionnaire-Revised both with and without application of an impairment and distress scale. Familial risk determination was based on agreement between four separate self-report assessments. RESULTS: The first group consumed significantly more alcohol than the other two groups, which did not differ in alcohol consumption. The first group's subjects were more likely to meet criteria for virtually all of the PD diagnoses than were the other two groups. A greater proportion of the second group's subjects qualified for various PDs than did the third group's subjects. Personality pathology was consistently or usually associated with more drinking in the first and third groups, respectively, but associated with less consumption in the second group. CONCLUSIONS: Young men with high-density familial alcoholism are at greater risk for the development of alcoholism than those with alcoholic fathers and little additional familial alcoholism. Relationships between personality pathology and alcohol consumption, and possibly the development of alcoholism, differ for the three risk groups.

Adult↗

PubMed1998

Twelve-month abstinence from alcohol and long-term drinking and marital outcomes in men with severe alcohol problems.

OBJECTIVE: Clinical and research data suggest that drinking behavior during the first year following treatment for alcohol problems may predict longer term drinking and functioning in other areas. The purpose of this study was to investigate the relationship between abstinence from alcohol during the first year following group behavioral marital therapy (BMT) for alcohol problems and drinking and marital functioning through 30 months post-group BMT. METHOD: The subjects were 73 white male veterans with severe alcohol problems who participated in a clinical trial of group BMT and individual BMT aftercare. All subjects who entered the clinical trial were classified as either abstinent from alcohol for the full first 12 months following completion of group BMT, or not. Following completion of group BMT, subjects were reevaluated on drinking, marital functioning and related behaviors at 3, 6, 12, 18, 24 and 30 months later. RESULTS: Outcome analyses, taking into account baseline differences between drinker groups on age, marital functioning and number of days light drinking, showed better alcohol use (18, 24 and 30 months) and marital functioning (6, 12, 18, 24 and 30 months) for the first-year abstainers. Furthermore, fewer first-year abstainers than drinkers reported they were hospitalized for alcohol-related reasons at the 18-, 24- and 30-month follow-ups, and the abstainers showed a greater degree of self-efficacy not to drink heavily at each of the 6-, 18- and 30-month follow-ups. CONCLUSIONS: The data are consistent with the literature in showing the prognostic value of first-year post-alcohol treatment abstinence for drinking and functioning in other life areas in the longer term. The findings suggest that at least shorter term abstinence should be considered as an outcome goal for individuals who present to alcohol treatment settings.

Adult↗

PubMed1997

Validity of three measures of antisociality in predicting HIV risk behaviors in methadone-maintenance patients.

Most opiate users are injection drug users (IDUs). A significant percentage of IDUs have antisocial personality disorder (APD). APD has been found by some researchers to be an additional risk factor for human immunodeficiency virus (HIV) infection in IDUs. The present study evaluated the association of sociodemographic characteristics, substance abuse history, and several measures of antisociality including the DSM-III-R diagnosis made by the Personality Disorder Examination, the California Psychological Inventory-Socialization Scale, and Hare's Revised Psychopathy Checklist, to behaviors associated with HIV risk in 289 opiate-dependent methadone-maintained subjects. The presence of drug- and sex-related risky behaviors measured by the Risk Assessment Battery was predicted more consistently by measures of personality traits associated with antisociality than by a diagnosis of APD.

Adult↗

PubMed1997

A cocaine-positive baseline urine predicts outpatient treatment attrition and failure to attain initial abstinence.

The primary study objective was to ascertain whether a prior finding that the baseline cocaine urine toxicology predicted treatment dropout for cocaine dependent outpatients could be extended to three additional cocaine dependent outpatient treatment samples and whether the urine toxicology also predicted attainment of initial abstinence for the four samples. A secondary objective was to ascertain the extent to which other baseline variables accounted for additional outcome variance over and above that afforded by urine toxicology. To evaluate the first objective, the relationships between the baseline cocaine urine and each of two measures of within treatment response--the completion of treatment or the attainment of initial abstinence--were determined for each of the treatment samples. The second objective was evaluated by a stepwise, hierarchical logistic regression analysis, with the urine toxicology entered in the first step, baseline Addiction Severity Index (ASI) variables in the second step, and achievement of initial abstinence as the outcome. In all four samples, patients with a urine indicative of recent cocaine use were less than half as likely to complete treatment or achieve initial abstinence. Individual ASI baseline variables did not contribute statistically significant variance over and above that predicted by the cocaine urine toxicology. The findings confirm the utility of the initial cocaine urine as a predictor of unfavorable outpatient treatment response.

Adult↗

PubMed1997

Validity of the psychopathy checklist-revised in male methadone patients.

The psychopathy checklist-revised (PCL-R) has been shown to be reliable when used with male methadone patients, but validity has not been established in this population. This paper examines the PCL-R's validity in 251 male methadone patients. Correlations between the PCL-R and background variables, Axis I and Axis II disorders, and several self report measures of related constructs are evaluated. Correlations with Axis I disorders were low except for substance dependencies, but strong correlations between Cluster B personality disorders were found. Results provide evidence of construct validity for the PCL-R, particularly total and Factor 2 scores, in male methadone patients.

Adolescent↗

PubMed1997

Group counseling versus individualized relapse prevention aftercare following intensive outpatient treatment for cocaine dependence: initial results.

Ninety-eight male cocaine-dependent patients who completed an intensive outpatient program (IOP) were randomly assigned to either standard group counseling (STND) or individualized relapse prevention (RP) aftercare. Heavier cocaine and alcohol use during IOP and low self-efficacy predicted more cocaine use during the treatment phase of the study, whereas lifetime diagnoses of alcohol dependence, major depression, and any anxiety disorder predicted less cocaine use. Rates of complete abstinence during the 6-month study period were higher in STND than RP, whereas RP was more effective in limiting the extent of cocaine use in those who used during Months 1-3. Matching analyses indicated patients who failed to achieve remission from cocaine dependence during IOP and those with a commitment to absolute abstinence did better in RP than in STND, whereas patients with other abstinence goals did better in STND than RP. Several differences in experiences before cocaine use and "near-miss" episodes were also identified.

Adult↗