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At least 19 recordsLinked to original sources
PubMed2001

Use of the MMPI-A to detect substance abuse in a juvenile correctional setting.

In this study, we examined the ability of the MMPI-A (Butcher et al., 1992) to detect substance abuse problems in a juvenile correctional setting. Specifically, we evaluated the Alcohol/Drug Problem Acknowledgment scale (ACK; Weed, Butcher, & Williams, 1994), the Alcohol/Drug Problem Proneness scale (PRO; Weed et al., 1994), and the MacAndrew Alcoholism Scale-Revised (MAC-R; Butcher et al., 1992) in the prediction of substance abuse. In addition, the incremental validity of ACK in comparison to PRO was evaluated, as was the incremental validity of PRO in comparison to ACK. The sample consisted of 123 boys and girls from ajuvenile correctional facility in Northeastern Ohio. Results indicate that ACK and PRO, but not MAC-R, were related to interviewer ratings of substance abuse. Results point to the superiority of ACK over PRO in substance abuse identification.

Adolescent↗
PubMed1997

Sensitivity of MCMI-III Scales T (drugs) and B (alcohol) in detecting substance abuse.

The sensitivity and specificity of MCMI-III Scales T (drug dependence) and B (alcohol dependence) were evaluated with patients (N = 164) in an inpatient substance user treatment program. The sensitivity levels of these two scales improved significantly compared to previous research using the MCMI I and MCMI II Scales T and B, which had not achieved sensitivity values above .50. However, specificity for detecting alcoholism among drug misusers was lower compared to MCMI I and II studies. Results suggest improved diagnostic sensitivity with the MCMI-III in diagnosing substance misuse, but lowered efficiency in ruling out the disorder.

Adult↗
PubMed1990

Potential substance abuse. Detection among adolescent patients. Using the Drug and Alcohol Problem (DAP) Quick Screen, a 30-item questionnaire.

The authors administered an abbreviated revision of a previously field-tested, self-administered, brief screening test (the 30-item Drug and Alcohol Problem Quick Screen) to 355 consecutive middle-class adolescent patients seen at a five-pediatrician group practice setting. Ninety-six percent (341) of the subjects completed the 30-item screening questionnaire. Eighty-nine percent of the 341 responders wrote in their names in the space provided for that purpose. Fifty-two patients (approximately 15%) of the 341 responded "yes" to six or more items in the current study. Based on a previous study comparing scores from 200 adolescents from the same pediatric practice with answers from 100 identified adolescent drug abusers at a drug abuse treatment facility, those patients with a score of 6 or more were considered high risk for "red flag" behaviors, particularly drug or alcohol abuse. Forty (77%) of those patients who scored six or greater identified themselves by name. Four key items on the questionnaire accounted for 70 percent of the variation between those at high and those at low risk for drug or alcohol abuse. These four most important items encompassed 1) use of tobacco products; 2) accusation by others of having a drinking or drug problem; 3) school suspension; and 4) riding in a motor vehicle with a driver who drank too much. The DAP Quick Screen appears to be practical as a screening tool in physician's offices for detection of serious problems during adolescence.

Adolescent↗
PubMed1990

The use of the MacAndrew Alcoholism Scale in detecting substance abuse and antisocial personality.

We evaluated the hypothesis that characterological factors, particularly antisocial personality, influence scores on the MacAndrew Alcoholism Scale (MAC). Using the Washington University research criteria to establish diagnoses, the following subgroups were defined: subjects who received no psychiatric diagnoses; subjects who received diagnoses other than alcoholism, drug dependence, or antisocial personality; and subjects who received a diagnosis of alcoholism, drug dependence, and/or antisocial personality, alone or in combination with other psychiatric diagnoses. The highest MAC scores were obtained by subjects diagnosed as having antisocial personality without alcoholism or drug dependence and subjects diagnosed with antisocial personality, drug dependence, and alcoholism. Alcoholics without antisocial personality or drug dependence, and subjects with other psychiatric diagnoses scored lowest. Although higher MAC scores were obtained by males, MAC scores greater than 24 correctly classified the greatest number of males and females as alcoholic, drug dependent and/or antisocial. These findings are interpreted as consistent with MacAndrew's reinterpretation of the scale as assessing a dimension of personality, rather than solely a tendency to addiction.

Adult↗
PubMed1996

Beyond CAGE. A brief clinical approach after detection of substance abuse.

Generalist physicians should incorporate alcohol and drug abuse detection and brief intervention in the care of their patients. A suggestion of alcohol or drug abuse or a positive response to the CAGE questions deserves further assessment such as clarification about adverse consequences, inquiry about loss of control, determination of the patient's perception of the substance use, and an assessment of the patient's readiness to change behavior. Brief intervention with the patient in the clinical setting about alcohol or drug use can be effective. Motivational interviewing, a directive, patient-centered counseling style for enhancing motivation for change, can make brief interventions more effective by incorporating the patient's readiness to address alcohol or drug use. A useful clinical approach is presented that is tailored to the patient's stage of readiness to change alcohol or drug abuse behavior.

Attitude to Health↗
PubMedDate not supplied

The substance abuse subtle screening inventory is more cost effective and has better selectivity than urine toxicology for the detection of substance abuse in pregnancy.

OBJECTIVE: To compare the SASSI as a screen for substance abuse in pregnancy with the patient history and toxicology screening. STUDY DESIGN: On 560 patients the substance abuse history and urine toxicology was obtained at registration in the prenatal clinic. Each patient also completed the SASSI questionnaire. The SASSI was compared with each screen individually and the result of the SASSI and the patient's history were combined for comparison with the toxicology results. RESULTS: SASSI was found to be more selective as a screen for substance abuse than urine toxicology and it gave a profile of alcohol use which was absent on the toxicology screen. CONCLUSIONS: The SASSI is a more effective clinical tool for identifying substance abuse and more cost effective than toxicology screening.

Adolescent↗
PubMed1993

Consumption of buprenorphine and other drugs among heroin addicts under ambulatory treatment: results from cross-sectional studies in 1988 and 1990.

We assessed the prevalence of consumption of buprenorphine and other drugs among heroin addicts under ambulatory treatment in two cross-sectional studies conducted in 1988 (188 subjects) and in 1990 (197 subjects). Patients were enrolled in one of three different programmes: methadone maintenance programme (MMP), antagonist maintenance programme (AMP) and drug-free programme (DFP). Information given by participants was compared with results of urine screening for drugs. Urine samples were tested using enzyme immunoassay for the detection of heroin, cocaine, dextropropoxyphene, cannabis and benzodiazepines, and radioimmunoassay for buprenorphine. Sixty-six percent of patients in 1988 and 71% of patients in 1990 reported having consumed buprenorphine at some time during their history of drug dependence (period prevalence) and 5.9% and 6.1%, respectively, tested positive to the drug (point prevalence). In over 70% of these patients consumption was by the intravenous route. Consumption of cannabis, cocaine and benzodiazepines was also very high in the study population. Overall, patients in the DFP group consumed the largest number of the drugs tested, while those in the AMP group consumed the smallest number. Abuse of buprenorphine could be more widespread than previously reported.

Adult↗
PubMed1998

Detection of methadone, methadone metabolites, and other illicit drugs of abuse in hair of methadone-treatment subjects.

The disposition of methadone, its metabolites, and other illicit drugs of abuse was investigated in head hair samples collected from heroin users (N = 20) enrolled in an outpatient detoxification study. Hair samples were assayed for methadone, methadone primary metabolite (2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine, EDDP), methadone secondary metabolite (2-ethyl-5-methyl-3,3-diphenylpyrroline, EMDP), cocaine, phencyclidine, heroin, and 6-acetylmorphine. Hair samples were cut, washed, and incubated in methanol. The methanolic hair wash and incubation fractions were purified with solid-phase extraction and assayed by gas chromatography-mass spectrometry. Methadone, methadone metabolites, cocaine, and phencyclidine were assayed quantitatively, and other drugs were measured qualitatively. The number of positive results and the corresponding concentration ranges were as follows: methadone, 0-15.0 ng/mg (N = 18); EDDP, trace (N = 13); EMDP, trace (N = 1); cocaine, 0->40 ng/mg (N = 14); phencyclidine, 0-1.5 ng/mg (N = 2); heroin, positive (N = 3); and 6-acetylmorphine, positive (N = 4). These data suggest that testing hair for methadone, methadone metabolites, and other illicit drugs of abuse may be useful to drug-treatment specialists as a means of verifying drug-use history, monitoring compliance, and providing a broad measure of drug exposure.

Gas Chromatography-Mass Spectrometry↗
PubMed1996

Clinical evaluation of the Triage analytic device for drugs-of-abuse testing.

In the present clinical evaluation of Triage immunoassay for detection of drugs of abuse, we examined a possible connection between the laboratory skills of the personnel using it and the quality of analytical results; we also evaluated the degree of concordance between the Triage results and those obtained by an instrumented fluorescence polarization immunoassay (FPIA). Three groups of evaluators with different laboratory skills and two sets of urine samples from subjects with different rates of drug consumption prevalence were included in the study. Urines were analyzed by the Triage analytical device at the collection site. A second analysis was performed in a toxicology laboratory, and the results were compared with those obtained by FPIA. Nonconcordant results were confirmed by gas chromatography-mass spectrometry and HPLC. Results were independent of the laboratory skills of the evaluators. The agreement for each drug calculated for two populations with differences in prevalence of drug consumption was almost the same, except for benzodiazepines. No differences between Triage and FPIA results were observed for samples clearly over or under cutoff concentrations. Globally, the Triage device, in a clinical situation, demonstrated performance comparable with that of an instrument-based immunoassay and, in some cases (e.g., for benzodiazepines), the Triage performance was even better.

Adult↗
PubMed1996

Sustained cocaine abstinence in methadone maintenance patients through voucher-based reinforcement therapy.

BACKGROUND: Chronic cocaine abuse remains a serious and costly public health problem. This study assessed the effectiveness of a voucher-based reinforcement contingency in producing sustained cocaine abstinence. METHODS: A randomized controlled trial compared voucher-based reinforcement of cocaine abstinence to noncontingent voucher presentation. Patients were selected from 52 consecutively admitted injecting heroin abusers in a methadone maintenance treatment program. Patients with heavy cocaine use during baseline period (N = 37) participated. Except where otherwise indicated, the term cocaine abuse is used in this article in a generic sense and not according to the DSM-III-R definition. Patients exposed to abstinence reinforcement received a voucher for each cocaine-free urine sample (ie, negative for benzoylecgonine) provided three times per week throughout a 12-week period; the vouchers had monetary values that increased as the number of consecutive cocaine-free urine samples increased. Control patients received noncontingent vouchers that were matched in pattern and amount to the vouchers received by patients in the abstinence reinforcement group. RESULTS: Patients receiving vouchers for cocaine-free urine samples achieved significantly more weeks of cocaine abstinence (P = .007) and significantly longer durations of sustained cocaine abstinence (P = .001) than controls. Nine patients (47%) receiving vouchers for cocaine-free urine samples achieved between 7 and 12 weeks of sustained cocaine abstinence; only one control patient (6%) achieved more than 2 weeks of sustained abstinence. Among patients receiving vouchers for cocaine-free urine samples, those who achieved sustained abstinence ( > or = 5 weeks) had significantly lower concentrations of benzoylecgonine in baseline urine samples than those who did not achieve sustained abstinence (P < or = .01). Patients receiving voucher reinforcement rated the overall treatment quality significantly higher than controls (P = .002). CONCLUSION: Voucher-based reinforcement contingencies can produce sustained cocaine abstinence in injecting polydrug abusers.

Adult↗
PubMed1999

A national evaluation of treatment outcomes for cocaine dependence.

BACKGROUND: This national study focused on posttreatment outcomes of community treatments of cocaine dependence. Relapse to weekly (or more frequent) cocaine use in the first year after discharge from 3 major treatment modalities was examined in relation to patient problem severity at admission to the treatment program and length of stay. METHODS: We studied 1605 cocaine-dependent patients from 11 cities located throughout the United States using a naturalistic, nonexperimental evaluation design. They were sequentially admitted from November 1991 to December 1993 to 55 community-based treatment programs in the national Drug Abuse Treatment Outcome Studies. Included were 542 patients admitted to 19 long-term residential programs, 458 patients admitted to 24 outpatient drug-free programs, and 605 patients admitted to 12 short-term inpatient programs. RESULTS: Of 1605 patients, 377 (23.5%) reported weekly cocaine use in the year following treatment (dropping from 73.1% in the year before admission). An additional 18.0% had returned to another drug treatment program. Higher severity of patient problems at program intake and shorter stays in treatment (<90 days) were related to higher cocaine relapse rates. CONCLUSIONS: Patients with the most severe problems were more likely to enter long-term residential programs, and better outcomes were reported by those treated 90 days or longer. Dimensions of psychosocial problem severity and length of stay are, therefore, important considerations in the treatment of cocaine dependence. Cocaine relapse rates for patients with few problems at program intake were most favorable across all treatment conditions, but better outcomes for patients with medium- to high-level problems were dependent on longer treatment stays.

Adult↗
PubMed2000

Methadone dose increase and abstinence reinforcement for treatment of continued heroin use during methadone maintenance.

BACKGROUND: Although methadone maintenance is an effective therapy for heroin dependence, some patients continue to use heroin and may benefit from therapeutic modifications. This study evaluated a behavioral intervention, a pharmacological intervention, and a combination of both interventions. METHODS: Throughout the study all patients received daily methadone hydrochloride maintenance (initially 50 mg/d orally) and weekly counseling. Following baseline treatment patients who continued to use heroin were randomly assigned to 1 of 4 interventions: (1) contingent vouchers for opiate-negative urine specimens (n = 29 patients); (2) methadone hydrochloride dose increase to 70 mg/d (n = 31 patients); (3) combined contingent vouchers and methadone dose increase (n = 32 patients); and (4) neither intervention (comparison standard; n = 28 patients). Methadone dose increases were double blind. Vouchers had monetary value and were exchangeable for goods and services. Groups not receiving contingent vouchers received matching vouchers independent of urine test results. Primary outcome measure was opiate-negative urine specimens (thrice weekly urinalysis). RESULTS: Contingent vouchers and a methadone dose increase each significantly increased the percentage of opiate-negative urine specimens during intervention. Contingent vouchers, with or without a methadone dose increase, increased the duration of sustained abstinence as assessed by urine screenings. Methadone dose increase, with or without contingent vouchers, reduced self-reported frequency of use and self-reported craving. CONCLUSIONS: In patients enrolled in a methadone-maintainence program who continued to use heroin, abstinence reinforcement and a methadone dose increase were each effective in reducing use. When combined, they did not dramatically enhance each other's effects on any 1 outcome measure, but they did seem to have complementary benefits.

Adult↗
PubMed2004

Remission from drug dependence symptoms and drug use cessation among women drug users in puerto rico.

BACKGROUND: Studies of remission from drug dependence have most often been based on treatment samples, with limited generalizability to persons who may benefit from but never seek substance abuse treatment. Little is known about remission patterns among drug users in the community. OBJECTIVE: To identify patterns and predictors of remission in a community sample of drug users followed up prospectively. DESIGN: Three waves of data on a range of individual and interpersonal correlates of drug abuse and health care service use were collected between April 1997 and October 2000. SETTING: Areas of metropolitan San Juan where drug sales were known to occur. PARTICIPANTS: Two hundred seventy-five women aged 18 to 35 who were crack cocaine or injecting drug users. MAIN OUTCOME MEASURES: Self-reported drug use validated with urine screens and drug use dependence criteria based on the DSM-IV. RESULTS: Most (86.9%) of the women were drug dependent at baseline. By wave 3, fewer than half (42.6%) of the women were dependent, 13.8% had subthreshold disorder, and 17.8% used substances but did not endorse any dependence criteria. Cessation of use and decreases in the number of dependence criteria endorsed were significantly less likely for women with depressive symptoms (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.88-0.96; and OR, 0.88; 95% CI, 0.86-0.90; respectively), with a partner who engaged in criminal activities (OR, 0.30; 95% CI, 0.16-0.58; and OR, 0.63; 95% CI, 0.46-0.85; respectively), and who traded sex for money or drugs (OR, 0.12; 95% CI, 0.05-0.29; and OR, 0.26; 95% CI, 0.19-0.35; respectively). CONCLUSIONS: Drug use patterns and rates of dependence fluctuated substantially over time among drug users recruited from the community. Findings regarding the characteristics that impede remission suggest that mental health practitioners have an important role to play in community-based outreach and interventions designed to support women's efforts to stop using drugs.

Adult↗
PubMed2005

Effect of prize-based incentives on outcomes in stimulant abusers in outpatient psychosocial treatment programs: a national drug abuse treatment clinical trials network study.

CONTEXT: Contingency management interventions that provide tangible incentives based on objective indicators of drug abstinence are efficacious in improving outcomes in substance abusers, but these treatments have rarely been implemented in community-based settings. OBJECTIVE: To evaluate the efficacy of an abstinence-based contingency management intervention as an addition to usual care in community treatment settings. DESIGN: Random assignment to usual care or usual care plus abstinence-based incentives for 12 weeks. SETTING: Eight community-based outpatient psychosocial drug abuse treatment programs. PARTICIPANTS: A total of 415 cocaine or methamphetamine users beginning outpatient substance abuse treatment. INTERVENTION: All participants received standard care, and those assigned to the abstinence-based incentive condition also earned chances to win prizes for submitting substance-free urine samples; the chances of winning prizes increased with continuous time abstinent. MAIN OUTCOME MEASURES: Retention, counseling attendance, total number of substance-free samples provided, percentage of stimulant- and alcohol-free samples submitted, and longest duration of confirmed stimulant abstinence. RESULTS: Participants assigned to the abstinence-based incentive condition remained in treatment for a mean +/- SD of 8.0 +/- 4.2 weeks and attended a mean +/- SD of 19.2 +/- 16.8 counseling sessions compared with 6.9 +/- 4.4 weeks and 15.7 +/- 14.4 sessions for those assigned to the usual care condition (P<.02 for all). Participants in the abstinence-based incentive condition also submitted significantly more stimulant- and alcohol-free samples (P<.001). The abstinence-based incentive group was significantly more likely to achieve 4, 8, and 12 weeks of continuous abstinence than the control group, with odds ratios of 2.5, 2.7, and 4.5, respectively. However, the percentage of positive samples submitted was low overall and did not differ between conditions. CONCLUSION: The abstinence-based incentive procedure, which provided a mean of 203 dollars in prizes per participant, was efficacious in improving retention and associated abstinence outcomes.

Adult↗
PubMed2006

Effects of lower-cost incentives on stimulant abstinence in methadone maintenance treatment: a National Drug Abuse Treatment Clinical Trials Network study.

BACKGROUND: Contingency management interventions that provide tangible incentives based on objective indicators of drug abstinence have improved treatment outcomes of substance abusers, but have not been widely implemented in community drug abuse treatment settings. OBJECTIVE: To compare outcomes achieved when a lower-cost prize-based contingency management treatment is added to usual care in community methadone hydrochloride maintenance treatment settings. DESIGN: Random assignment to usual care with (n = 198) or without (n = 190) abstinence incentives during a 12-week trial. SETTING: Six community-based methadone maintenance drug abuse treatment clinics in locations across the United States. PARTICIPANTS: Three hundred eighty-eight stimulant-abusing patients enrolled in methadone maintenance programs for at least 1 month and no more than 3 years. INTERVENTION: Participants submitting stimulant- and alcohol-negative samples earned draws for a chance to win prizes; the number of draws earned increased with continuous abstinence time. MAIN OUTCOME MEASURES: Total number of stimulant- and alcohol-negative samples provided, percentage of stimulant- and alcohol-negative samples provided, longest duration of abstinence, retention, and counseling attendance. RESULTS: Submission of stimulant- and alcohol-negative samples was twice as likely for incentive as for usual care group participants (odds ratio, 1.98; 95% confidence interval, 1.42-2.77). Achieving 4 or more, 8 or more, and 12 weeks of continuous abstinence was approximately 3, 9, and 11 times more likely, respectively, for incentive vs usual care participants. Groups did not differ on study retention or counseling attendance. The average cost of prizes was 120 dollars per participant. CONCLUSION: An abstinence incentive approach that paid 120 dollars in prizes per participant effectively increased stimulant abstinence in community-based methadone maintenance treatment clinics.

Adult↗
PubMed1995

Characterization of dextromoramide (Palfium) abuse by hair analysis in a denied case.

By providing information on exposure to drugs over time, hair analysis is useful in verifying the history of drug use. In a clinical case, where drug abuse was denied, it was possible to identify dextromoramide in the hair of the subject. After acid hydrolysis of the hair with 0.1 M HCl, in the presence of SKF 525A as an internal standard, the drug was extracted at pH 8.4 with chloroform-isopropanol-n-heptane (50:17:33 v/v) and quantified by gas chromatography/mass spectrometry. The hair strands were cut into 3 sections of 2.5 cm, corresponding to a growth period of 2 months. Concentrations were 1.09, 1.93 and 1.48 ng/mg from the root to the end, respectively. This is the first report on dextromoramide testing in human hair.

Dextromoramide↗