Effect of methadone plus neuroleptics on treatment-resistant chronic paranoid schizophrenia.

In a placebo-controlled single-crossover study, seven patients with treatment-resistant chronic paranoid schizophrenia who received methadone plus neuroleptic showed significant improvement. Methadone may be a useful adjunctive treatment in a subpopulation of patients with chronic paranoid schizophrenia.

Outcomes for cocaine abusers after once-a-week psychosocial therapy.

OBJECTIVE: The authors studied the efficacy of once-weekly psychotherapy, family therapy, or group therapy led by paraprofessionals among patients with cocaine use disorders. METHOD: Of subjects who sought outpatient treatment, 168 consented to participate in the study and were each randomly assigned to one of the three forms of therapy; 122 patients were interviewed 6-12 months later. Their pre- and posttreatment scores on the Addiction Severity Index were compared. RESULTS: Significant improvements were observed for the cohort as a whole, but virtually all of the improvement was restricted to the 23 subjects (19%) who were not using cocaine at follow-up. There was a strong relationship between abstinence from cocaine use and absence of addiction-related problems, especially psychiatric symptoms and family problems. CONCLUSIONS: The results of the study indicate that outpatient therapy once a week is ineffective for cocaine use disorder. The 19% abstinence rate probably represents spontaneous remission among patients with enough motivation to seek treatment, as the number of therapy sessions attended was not related to improvement. Either an intense level of outpatient contact or residential treatment followed by aftercare is probably needed, at least initially, while the patient is attempting to initiate and sustain abstinence.

Evaluation and clinical management of cocaine abusers.

The development of an individualized treatment program for cocaine abusers requires a comprehensive assessment of the psychobiological, social, and pharmacological elements that determined the drug abuse behavior as well as those elements that resulted from the behavior. A working knowledge of the "disease model" of chemical dependency, as well as other relevant models, is mandatory. Although the existing outcome data are insufficient, there is a large array of possible treatment options and facilities; the clinician should attempt to match the patient with the program based on relevant clinical and anecdotal information. Clinicians should be familiar with the ethos and procedures of the "12-Step programs"; they are often a critical element in treatment.

Patterns of use and psychopathology in chronic marijuana users.

After an epidemic increase in the use of marijuana from the mid 1960s to the late 1970s, there appears to be a recent decrease in the prevalence of use. Patterns of use of marijuana vary considerably depending upon the socio-cultural and psychobiologic characteristics of the user. There may also be a natural history of marijuana use in individuals that is influenced importantly by the age and perspectives of the user. Marijuana use has been shown to be an important cause of psychopathology in some people and an attempt at self-medication in others.

Pathological gambling among methadone patients.

This paper examines the correlates of problem gambling among a population of 220 methadone patients receiving treatment in the New York metropolitan area. Like most methadone patients, respondents were primarily adult males, ethnically mixed, of limited educational accomplishment and had long experiences with intravenous drug use. More than two-thirds of subjects had been convicted of one or more criminal offences. Analysis of the data showed seven percent of respondents to be probable pathological gamblers according to the South Oaks Gambling Screen (SOGS), indicating a high rate of gambling problems among this treatment population. Consistent with past studies, problem gamblers are more likely to be men, with histories of alcohol abuse, and with extensive criminal participation dating back to their teenage years. The data also suggested that problem gamblers who were also drug dependent were more likely to show greater evidence of social dysfunctionality compared to those who were exclusively substance abusers. More dually addicted respondents reported higher levels of recent heroin use, greater unemployment, and more reported hallucinations. Probable pathological gamblers who were substance abusers were also more likely to report being in conflict with their close friends. A multiple regression analysis suggested this to be the closest linked correlate to being a pathological gambler. Evidently, pathological gamblers create antipathy towards themselves as their compulsion to gamble is expressed; this in turn, may drive them toward further gambling, as they respond to this perceived opposition. These last preliminary findings will require further confirmation in future research.

Pharmacology of the drugs of abuse and the development of public policy.

It is fascinating that the morality, ethics, and effectiveness of current drug prohibition policies are being criticized in an era when drug use is declining in most segments of society. The current era is also marked by increasingly restrictive policies against drug use and users, including much enhanced interdiction efforts, calls for tougher penalties and more jails, and extensive drug screening programs at the work site. Summary dismissal of workers or students who use drugs is increasingly advocated. Two distinct and opposing currents advocating policy change have emerged, one for legalization, the other for greater restriction. The current inner-city rise in drug use, particularly of cocaine and "crack," and the remarkable increase in drug-related crime is probably providing the impetus for both lines of thinking. Yet both views appear extreme and neither seems to offer a promising social policy. It is critical that we continue to attempt to develop effective strategies for reducing the impact of drug taking on the individual and society. Whereas I am sensitive to the ethical and legal perspectives of the proponents of legalization, pharmacologic and social issues persuade me that legalization of heroin and cocaine would lead to a marked increase in drug dependence and an increase in drug-related disability and crime. In response to the idea that the legalization and taxation of drug use would provide resources for more effective research, prevention, and treatment, my sense is that we should not wait for legalization but should embark on that long and expensive course immediately.(ABSTRACT TRUNCATED AT 250 WORDS)

Considerations on the psychotherapy of the substance abuser.

Psychotherapy is an important treatment option for many substance abuse patients. There are some similarities but important differences in psychotherapeutic procedures with substance abusers as compared to other psychiatric patients. The primary goal of the treatment process must be abstinence; resolution of psychological conflicts is not a necessary condition for the achievement or maintenance of abstinence. The initial treatment phase including development of a therapeutic alliance often requires the therapist to take an active educational and conforntative role. The pharmacology and patterns of abuse of the drugs should be well understood. Twelve-step programs such as Alcoholic Anonymous (AA) are a valuable component of the treatment process; psychotherapists must be sensitive to the ethos and procedures of these programs.

A common cause of alcoholism.

A common cause of alcoholism is the nonalcoholic. At least half of the nonalcoholics have a family member who is not alcoholic. The classic "enabler" is the caretaker of the alcoholic. Without the enabler, alcoholism would dwindle. The so-called innocent bystanders are not consciously intending to harm the alcoholic. Most of the time there is no conscious intention to help the alcoholic continue drinking and inflicting self-destruction. The innocent bystander must become guilty. The guilty must confront the alcoholic with the consequences of alcoholism. The concerned must refuse to make excuses for the alcoholic's failure and resentment. The innocent bystander may lack willpower more than the alcoholic by refusing to look alcoholism in the eye.

The diagnosis of alcohol, cocaine, and other drug dependence in an inpatient treatment population.

The diagnosis of alcohol, cocaine, and other drug dependence in inpatient treatment populations is important to identify for clinical prognosis, treatment, and genetic research. The use of alcohol by cocaine addicts is a common cause for relapse to cocaine. The treatment of cocaine addiction is simplified if alcohol dependence is also present because the same methods can be used for both. In this study, 94% of those patients who qualified for the diagnosis of cocaine dependence were also diagnosed as having alcohol and other drug dependence. The demographic characteristics of these cocaine addicts (n = 413) compared to those patients with the diagnosis of alcohol dependence only (n = 677) and alcohol dependence and drug dependence other than cocaine (n = 453).

Lifetime needle sharing: a predictive analysis.

Through understanding predictors of needle sharing, it may be possible to design AIDS prevention interventions more effectively. Data were collected from a sample of 416 patients in two New York City methadone programs in 1990. Questions were asked about needle sharing and about a battery of predictors covering 11 psychosocial domains. Based on factor analysis, these were reduced to seven factors: criminal history, antisocial characteristics, social integration, severity of psychiatric problems, current drug involvement, physical health, and personality disorders. Bivariate analyses showed that criminal involvement, antisocial characteristics, social integration, and age were significantly related to needle sharing. With the seven factors, as well as age, gender, and ethnicity simultaneously examined by means of regression analysis, it was found that criminal involvement, severity of psychiatric problems, and age were all positively associated with needle sharing. Implications for treatment are discussed.

Prevention of alcohol misuse through the development of personal and social competence: a pilot study.

Seventh graders (N = 239) from two New York City junior high schools were involved in a 9-month study testing the efficacy of a broad-spectrum approach to prevention of alcohol misuse. The two schools were randomly assigned to experimental and control conditions. The seventh graders in the treatment school received a 20-session program targeted at the major cognitive, attitudinal, social and personality factors believed to promote the early stages of alcohol misuse. The program contained material on decision making, coping with anxiety, general social skills and assertiveness (including techniques for resisting peer pressure to drink) as well as information about the short- and long-term consequences of alcohol misuse. Complete pretest, posttest 1 and posttest 2 data were collected from 167 students (89 women). A significantly greater proportion of the students in the experimental group reported less frequent drinking (p less than .02), less drinking per occasion (p less than .04), and less frequent episodes of drunkenness (p less than .01) than the students in the control group.

Psychiatric comorbidity in methadone maintained patients.

Diagnosing comorbid psychiatric disorders in methadone maintained patients may help to identify subgroups with different outcomes and needs for treatment. In this study, 75 methadone maintenance clinic patients in treatment longer than 30 days were assessed with the Addiction Severity Index, Global Assessment Scale and Mini-Mental Status Exam, and were interviewed for DSM-III-R psychiatric diagnosis using the computerized Diagnostic Interview Schedule. Psychiatric diagnoses were prevalent in the sample with depression, phobic disorders, antisocial personality and generalized anxiety the most common. Both number of DSM-III-R diagnoses and severity of psychopathology were correlated with outcome measures such as concurrent drug abuse, family-social problems and employment status.

Amphetamines: pharmacology, abuse and addiction.

Amphetamine (beta-phenylisopropylamine) is a potent sympathomimetic amine of a simple structure with a multiplicity of biological effects that include hyperthermic, anorectic, cardiovascular and central nervous system stimulant actions. Since the 1930s a large number of drugs have been developed from systematic, chemical modifications of the basic amphetamine molecule to emphasize some of the properties of amphetamines and to eliminate or diminish others. These chemical manipulations have resulted in the synthesis of a variety of more selectively acting sympathomimetics. These altered molecules include CNS stimulants, potent psychomimetics (hallucinogens), anorectic agents, and vasoconstrictors that all have the basic beta-phenylisopropylamine skeleton. Reports of the consequences of abuse and addiction followed rather closely the development of these agents: manufacture, distribution and use continue to the present day. Both legitimate and illicit production account for a significant level of use of CNS stimulants. CNS stimulants are perhaps the most reinforcing drugs known to man. For this reason alone they will persist as drugs of choice among a variety of personalities.

Outcome at six and twelve months post inpatient treatment for cocaine and alcohol dependence.

This study presents outcome rates for inpatient treatment for alcohol, cocaine and other drug dependence. The abstinence rates at six and twelve months post discharge and other demographic information are compiled on 1,627 patients admitted to an inpatient treatment unit for the rehabilitation of cocaine, alcohol and other drug dependence. The percent of the 1,627 patients with the diagnosis of alcohol dependence only was 42%, cocaine, alcohol and other drug dependence 25%, and alcohol and other drugs, 28%. The abstinence rate at six months for patients with alcohol dependence only was 75%, alcohol and other drug dependence 82%, cocaine dependence 76%; at twelve months, the abstinence rates were 71%, 66%, and 62% respectively.

Clinical issues concerning alcoholic youthful narcotic abusers.

The combined addictive diseases of alcoholism and narcotics addiction are as common in the adolescent as in the adult population and have profound effects on health and outcome. Therefore proper clinical management of these patients requires the best available treatment of both the narcotic addiction and the best available treatment of the alcohol abuse problem. Alcoholism per se does not have negative effect on MMTP retention. Although methadone maintenance has been shown to be effective in the treatment of narcotics addiction in adolescents as well as in adults, methods and resources for the management of alcohol abuse within the modality are meager, parochial, and poorly defined. Future efforts must be directed towards developing more effective models for the treatment of the combined addictions.

Retention of cocaine abusers in outpatient psychotherapy.

Retention in outpatient psychotherapy of 148 crack and cocaine abusers was examined. The clients were predominantly Black (63%) and Hispanic (21%), predominantly male (87%), and the majority (66%) had completed no more than 12 years of high school. Clients entered treatment in a low-cost treatment center in New York City between June 1987 and November 1988. Forty-two percent (62) of the subjects were seen for one or two research interviews only, and did not return to begin therapy. Of the 86 persons who came to at least one therapy session, 30% (26) dropped out before the third session, 28% (24) dropped out between the third and fifth sessions, and 42% (36) were retained for six or more sessions. Short-term and longer-term retentions were analyzed separately, using a battery including sociodemographic variables, treatment history, psychiatric symptomatology, number of arrests, and drug use variables. None of the variables considered was significantly related to short-term retention. There were large although not significant differences in longer term retention by therapist. Longer-term retention was associated significantly with being White (contrasted with being Black) and being young. Nonsignificant but large associations were found between longer-term retention and having few arrests, being Hispanic (contrasted with being Black), and having low SCL-90 scores. Results are compared with previous findings about retention in drug and alcohol treatment. It is suggested that future research on retention in treatment focus less on client variables and more on therapist and program variables.

Psychopathology among cocaine abusers entering treatment.

A number of different indicators of psychopathology were assessed in this study of 76 cocaine and crack abusers who entered outpatient treatment in New York City between June and December 1987. The majority (75%) had used cocaine for 4 years or more, and the majority (62%) spent over one thousand dollars a month on cocaine in the 6 months before entry into treatment. Forty-seven percent of the sample were found to be clinically depressed. Phobic disorders were the only other axis I diagnoses found in addition to depression, and all persons who were found to have phobic disorders also were diagnosed as having some form of depressive disorder. The four most common axis II diagnoses were antisocial personality (21%), passive-aggressive (21%), borderline (18%) and self-defeating (18%). Subjects were classified as falling into one of the following three categories of a newly developed "psychopathology classification": a) no diagnosed psychopathology except substance abuse or dependency; b) one or more axis II diagnoses, but no axis I diagnoses except for substance abuse or dependency; c) at least one axis I diagnosis in addition to drug disorders whether or not accompanied by an axis II diagnosis. Mean scores on subscales and total score on the SCL-90, as well as total score on the Beck Depression Inventory, were ordered by category of the classification scheme, with those having no diagnosed psychopathology except substance abuse having the lowest score and persons in the third category having the highest score.(ABSTRACT TRUNCATED AT 250 WORDS)