Naltrexone combined with either cognitive behavioral or motivational enhancement therapy for alcohol dependence.

Although naltrexone has been shown to be effective in the treatment of alcohol dependence, less is known about its efficacy when combined with different behavioral therapies. Previous work has suggested that naltrexone works best when combined with weekly cognitive behavioral therapy (CBT). This study examined the efficacy of naltrexone when combined with CBT or a motivational enhancement therapy involving less patient contact. Outpatient alcoholics (N = 160) were randomly assigned to either naltrexone (50 mg/d) or placebo and either CBT (12 sessions) or motivational enhancement therapy (4 sessions), in a 4-cell design, and treated over a 12-week period. Subjects were evaluated periodically for alcohol consumption, craving, and biologic markers of drinking (carbohydrate-deficient transferrin and gamma-glutamyltransferase). There was high retention and adherence to therapy and medication in the trial with no significant difference across the treatment groups. Naltrexone, independent of therapy assignment, increased the time to first relapse. However, the CBT-naltrexone group did better than the other groups on a variety of outcome measures. Fewer CBT-naltrexone-treated subjects relapsed, and those that did had both fewer, and more time between, subsequent relapses. This randomized controlled trial is consistent with previous reports about the utility of combining naltrexone with CBT. Despite being more efficient to administer, the combination of motivational enhancement therapy and naltrexone is less effective than CBT and naltrexone. Because CBT and naltrexone share common mechanisms of action, such as craving reduction and relapse prevention, these therapies are likely to be well suited to use in combination.

Substance abuse treatment outcomes for cognitively impaired and intact outpatients.

The purpose of this research was to examine the effects of cognitive impairment on the efficacy of substance abuse treatment outcome. Alcohol, drug, medical, legal, psychological, employment, and family functioning related treatment outcomes were examined for 26 cognitively impaired and 68 cognitively intact abusing outpatients. Subjects were enrolled in an intensive, 3-week, outpatient program for the treatment of their substance abuse. Subjects were administered a battery of neuropsychological tests prior to treatment onset, and outcome data were obtained at 1, 3, 6, and 12 months posttreatment entry. No significant between-group differences were found on any of the outcome measures, and significant treatment gains were observed across all problem domains in both groups. Subjects' largest improvements were made in the first month of treatment for alcohol, drug, legal, family, and psychological problems. Improvements for employment and medical problems were not observed until 6 months posttreatment. Success across domains was maintained through 12 months follow-up, with the exception of psychological problems; 12-month data indicated a return to thelevel observed at 30 days posttreatment for psychological problems, a level that reflected significant improvement from baseline functioning. A greater proportion of treatment dropouts (i.e., no follow-up data obtained after 30 days) were cognitively impaired as compared to treatment completers. These results suggest that this method of intensive substance abuse outpatient treatment is effective for cognitively impaired patients, an important finding given that research evaluating the efficacy of interventions for such patients is limited. Additionally, neuropsychological evaluation may be important in reducing treatment dropouts, as the present findings indicated that greater cognitive impairment was related to an increased likelihood of treatment dropout.

Diarrhea prevention through household-level water disinfection and safe storage in Zambia.

A water quality intervention that consists of water treatment, safe storage, and community education was field tested in Kitwe, Zambia. A total of 166 intervention households were randomly selected from one community and 94 control households from another. Baseline surveys were conducted and the intervention was distributed. Weekly active diarrhea surveillance, biweekly water testing, and a follow-up survey were conducted. Compliance was high in intervention households: 97% reported using disinfectant and 72-95% had measurable chlorine in their water in biweekly testing. The percentage of intervention households storing water safely increased from 41.5% to 89.2%. Stored water in intervention households was significantly less contaminated with Escherichia coli than water in control households (P < 0.001). Diarrheal disease risk for individuals in intervention households was 48% lower than for controls (95% confidence interval = 0.3, 0.9). This intervention is a useful tool for preventing waterborne diseases in families in developing countries who lack access to potable water.

Baseline Differences in Social Support Among Treatment-Seeking Alcoholics With and Without Social Phobia.

Differences on demographics and seven measures of social support between matched, treatment-seeking alcoholics with and without social phobia (SP and NSP groups, respectively) were examined. The groups did not differ on most demographic variables, although the SP group (n = 397) had a lower occupational status and had fewer years of education (both p's <.01) than the NSP group (n = 397). On social support measures, the SP group had less perceived social support from friends and had a lower performance on the social behavior role scale than the NSP group (both p's <.001). The two groups were unexpectedly more similar than different on the measures of interest in this study; however, the differences identified are meaningful for treatment planning. It is important to ascertain the quantity and sources of social support which are available to these clients in order to maximize positive treatment outcomes.