RESUMO
Self-efficacy has been shown to be related to outcomes from interventions for alcohol and tobacco abuse but relatively little attention has been focused on it in evaluations of treatment for illicit drug abuse. Almost no research has examined offenders involved with drugs. The current study, therefore, adapted the Alcohol Abstinence Self-efficacy Scale of DiClemente, Carbonari, Montgomery, and Hughes and administered it to 250 probationers mandated to 6 months of residential treatment. With some modifications, confirmatory factory models replicated four previously reported dimensions, e.g., Negative Affect, Social/Positive, Physical and Other Concerns, Cravings and Urges. Findings also indicated high construct validity for the Alcohol Abstinence Self-efficacy Scale as adapted here. Studies are needed to examine the use of self-efficacy as a prospective measure of treatment progress and to explore its association with outcomes from corrections-based treatment.
Assuntos
Drogas Ilícitas , Prisioneiros/psicologia , Autoeficácia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inventário de Personalidade , Prognóstico , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Comunidade TerapêuticaRESUMO
Although one-third of clients enrolled in methadone treatment in the United States are female, few studies have looked at gender differences at admission and follow-up. Using interview data from 435 clients (31% female) collected at admission and approximately 1 year after discharge, females were found to have more dysfunctional families of origin and greater prior and current psychological and medical problems. Both genders improved following treatment, as evidenced by reduced illicit drug, tobacco, and alcohol use, criminal involvement, and HIV/AIDS-risky behaviors. Females were more likely to seek further help for both drug misuse and psychological problems subsequent to discharge.
Assuntos
Dependência de Heroína/reabilitação , Metadona/uso terapêutico , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Síndrome da Imunodeficiência Adquirida/epidemiologia , Adulto , Comorbidade , Crime/estatística & dados numéricos , Escolaridade , Relações Familiares , Feminino , Seguimentos , Infecções por HIV/epidemiologia , Dependência de Heroína/epidemiologia , Humanos , Masculino , Transtornos Mentais/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Admissão do Paciente/estatística & dados numéricos , Inventário de Personalidade , Escalas de Graduação Psiquiátrica , Assunção de Riscos , Fatores Sexuais , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos/epidemiologiaRESUMO
It is generally recognized that the evaluation of treatment progress requires multiple methods of assessment. To provide a basis for supplementing existing measures, the current study investigated the use of a peer rating methodology for evaluating the treatment progress of 381 probationers admitted to a four-month residential drug abuse facility. Self ratings of "working the program" (i.e., conscientiously participating in treatment) were compared with ratings by peers in the program and with ratings by counselors. Peer and counselor ratings were more highly correlated with each other than with client self ratings. Peer as well as self ratings detected differences between enhanced and standard counseling, and were related to individual difference measures known to be associated with treatment progress. In addition, peer midterm ratings of "working the program" were related to both self and counselor ratings of clients' endterm participation, and counselor ratings of the likelihood of remaining clean and sober. These findings support the use of peer ratings as additional indicators of treatment progress.
Assuntos
Aconselhamento , Grupo Associado , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Alcoolismo/reabilitação , Atenção , Cocaína Crack , Crime , Feminino , Dependência de Heroína/reabilitação , Humanos , Relações Interpessoais , Masculino , Abuso de Maconha/reabilitação , Análise Multivariada , Guias de Prática Clínica como Assunto , Relações Profissional-Paciente , Análise de Regressão , Estatísticas não Paramétricas , Centros de Tratamento de Abuso de Substâncias , Resultado do TratamentoRESUMO
Endoscopy is a valuable tool in the diagnosis and management of duodenal lesions and biliary strictures. We assessed the value of cytology in the evaluation of these lesions and analyzed the causes of discrepancy among clinical, histologic, and cytologic parameters. The study included 118 patients with duodenal ulcers, ampullary neoplasms, or biliary strictures who were examined between 1975 and 1995; 120 cytologic examinations were performed. The specimens included brushings of the duodenum (DB, n = 50), ampulla (AB, n = 32), and biliary ducts (BB, n = 38). Endoscopic biopsies performed concurrently included the duodenum (n = 37), the ampulla (n = 22), and the biliary ducts (n = 23). Comparison of cytologic and histologic results showed the following sensitivity and specificity: DB, 40% and 97%, respectively; AB, 100% each; BB, 75% and 93%, respectively. The DB, AB, and BB revealed malignant neoplasms in 2 of 5, 7 of 7, and 6 of 8 cases, respectively. Twenty-three duodenal neoplasms were diagnosed by either modality and included 11 adenocarcinomas, 9 villous tumors, 2 metastatic renal cell carcinomas, and 1 large cell non-Hodgkin's lymphoma. Endoscopic brush cytology is an effective means of diagnosing ampullary neoplasms, and it complements tissue biopsy in cases of bile duct stricture. Location, predominance of tumor-induced stroma, an extramucosal growth pattern, sampling error, and interpretative experience influence the diagnostic evaluation. Cytologic diagnosis of an adenoma does not exclude an underlying malignant neoplasm in ampullary tumors. In some instances, it may be difficult to distinguish between villous tumors with severe dysplasia and adenocarcinomas by cytology alone.
Assuntos
Ampola Hepatopancreática/patologia , Neoplasias do Sistema Biliar/diagnóstico , Citodiagnóstico/métodos , Neoplasias Duodenais/diagnóstico , Adenocarcinoma/patologia , Adenoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Sistema Biliar/patologia , Biópsia , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/secundário , Neoplasias Duodenais/patologia , Feminino , Humanos , Linfoma não Hodgkin/patologia , Masculino , Pessoa de Meia-IdadeRESUMO
Relationships with family and friends by 439 heroin addicts during the first 3 months of drug abuse treatment were examined in relation to behavioral improvements of clients. Family conflict and peer deviance were significant predictors of injection frequency and illegal activity during treatment, and reductions in family conflict were associated with lower drug use, injection frequency, and illegal activity during treatment. These results provide support for treatment emphasis on helping clients reduce conflict among family members, improve dysfunctional relationships with peers, and replace deviant friendships with others that encourage treatment participation and conformance to social norms.
Assuntos
Família/psicologia , Dependência de Heroína/reabilitação , Relações Interpessoais , Apoio Social , Adulto , Terapia Familiar , Feminino , Dependência de Heroína/psicologia , Humanos , Masculino , Grupo Associado , Conformidade Social , Abuso de Substâncias por Via Intravenosa/psicologia , Abuso de Substâncias por Via Intravenosa/reabilitaçãoRESUMO
OBJECTIVE: The purpose of this study was to clarify the relationship between heavy use of alcohol and response to methadone treatment. METHOD: A sample of clients showing three or more DSM-III-R symptoms (n = 79) were identified and compared with a sample of heavy-drinking clients (n = 108) with less than three alcohol dependency symptoms on admitting characteristics and on tenure in treatment. RESULTS: As expected, clients meeting DSM-III-R dependency criteria were significantly more likely to show evidence of psychological problems and dysfunction of family and peer relations at admission. An unexpected finding was that they were also more likely to remain in treatment longer than drinking clients who did not report dependency. Alcohol dependent clients were significantly more likely to have prior experience with self-help groups, which may reflect less denial and therefore relatively better ability to focus on opiate dependency problems. CONCLUSIONS: Failure to differentiate between alcohol dependent and nondependent groups of drinkers enrolled in methadone treatment may help account for reported differences in treatment outcome studies. Recognizing these different types of drinkers also may help clinicians plan more effective treatments.
Assuntos
Alcoolismo/epidemiologia , Dependência de Heroína/epidemiologia , Metadona/uso terapêutico , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adolescente , Adulto , Idoso , Alcoolismo/diagnóstico , Alcoolismo/psicologia , Alcoolismo/reabilitação , Comorbidade , Estudos Transversais , Mecanismos de Defesa , Feminino , Dependência de Heroína/psicologia , Dependência de Heroína/reabilitação , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/psicologia , Autorrevelação , Abuso de Substâncias por Via Intravenosa/psicologia , Abuso de Substâncias por Via Intravenosa/reabilitação , Texas/epidemiologia , Resultado do TratamentoRESUMO
Previous work has shown length of time in drug abuse treatment is associated with better outcomes, but the role of therapeutic engagement and process needs further examination. In this study, the total number of counseling sessions attended by 557 clients in their first 90 days of community-based outpatient treatment was examined in relation to indicators of treatment delivery and progress. Significant client improvements were found on behavioral criteria and psychosocial functioning during the first 3 months of treatment, and session attendance was positively related to favorable behavioral changes as well as to positive perceptions by clients and counselors of their therapeutic interactions. Client background, treatment motivation, and therapeutic focus of counseling in Month 1 were significant predictors of session attendance in the first 3 months following admission to methadone treatment.
Assuntos
Cocaína , Dependência de Heroína/reabilitação , Avaliação de Processos e Resultados em Cuidados de Saúde , Cooperação do Paciente/psicologia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto , Assistência Ambulatorial , Serviços Comunitários de Saúde Mental , Comorbidade , Feminino , Dependência de Heroína/psicologia , Humanos , Masculino , Metadona/uso terapêutico , Equipe de Assistência ao Paciente , Detecção do Abuso de Substâncias , Centros de Tratamento de Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/psicologiaRESUMO
HIV risks involving injection and sex behaviors were analyzed in relation to cocaine use and gender among 487 opiate-dependent clients in methadone treatment. Those who also used cocaine were at greater risk than non-cocaine users on HIV risky injection variables. Females were at more risk than males on the HIV risky sex behaviors involving unprotected sex in exchange for money or drugs and with injection users. There were interactions between cocaine use and gender, however, in relation to frequency of injecting with dirty works and sharing dirty works with strangers, as well as having unprotected sex for money or drugs, with injection users, and while intoxicated. HIV risks increased as a direct function of cocaine usage level among males, but not among females; instead, low-to-intermediate levels of cocaine use by females was associated with high-risk behaviors. Implications for HIV risk reduction interventions in drug treatment programs are discussed.
Assuntos
Cocaína , Infecções por HIV/transmissão , Dependência de Heroína/epidemiologia , Metadona/uso terapêutico , Abuso de Substâncias por Via Intravenosa/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Comorbidade , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Dependência de Heroína/reabilitação , Humanos , Masculino , Uso Comum de Agulhas e Seringas/efeitos adversos , Uso Comum de Agulhas e Seringas/estatística & dados numéricos , Fatores de Risco , Fatores Sexuais , Comportamento Sexual , Abuso de Substâncias por Via Intravenosa/reabilitação , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Texas/epidemiologiaRESUMO
The value of using a visual representation strategy, called node-linking mapping, was evaluated in individual and group drug abuse counseling settings. Methadone maintenance clients were randomly assigned to counselors trained to use mapping techniques (n = 57), and those who used standard counseling (n = 51). Clients in the mapping counseling group had more favorable perceptions of their own therapeutic engagement and progress as indicated by ratings of cognitive-behavioral and motivational attributes than did those in standard counseling. Overall, individual sessions were viewed by clients as being more valuable than group counseling, but the use of mapping increased the helpfulness attributed to group counseling to near the same level as individual counseling.
Assuntos
Terapia Cognitivo-Comportamental/métodos , Metadona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/reabilitação , Psicoterapia de Grupo/métodos , Adulto , Alcoolismo/psicologia , Alcoolismo/reabilitação , Cocaína , Terapia Combinada , Comorbidade , Intervenção em Crise , Feminino , Dependência de Heroína/psicologia , Dependência de Heroína/reabilitação , Humanos , Masculino , Motivação , Transtornos Relacionados ao Uso de Opioides/psicologia , Resolução de Problemas , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/reabilitaçãoRESUMO
Since 1985, many drug abuse treatment centers and health care providers have implemented special education programs for individuals who inject drugs. They focus primarily on increasing awareness of the threat of the human immunodeficiency virus (HIV) being spread through drug injection equipment and by sexual activities. As part of the Drug Abuse Treatment for AIDS-Risk Reduction (DATAR) project, the AIDS/HIV Risk Reduction Module was designed to meet these special intervention needs. This study examined program impact on 110 methadone treatment clients. Results indicated that for those in treatment less than 4 months, the AIDS intervention program enhanced specialized knowledge about AIDS, aided in the reduction of AIDS-risky behaviors, and enhanced attitudes toward achieving and maintaining abstinence from drug use. Thus, AIDS education and intervention programs appear to be effective and should be emphasized in the early phase of drug abuse treatment.
Assuntos
Síndrome da Imunodeficiência Adquirida/prevenção & controle , Dependência de Heroína/reabilitação , Metadona/uso terapêutico , Educação de Pacientes como Assunto , Abuso de Substâncias por Via Intravenosa/reabilitação , Síndrome da Imunodeficiência Adquirida/transmissão , Adulto , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Dependência de Heroína/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Uso Comum de Agulhas e Seringas/efeitos adversos , Uso Comum de Agulhas e Seringas/psicologia , Avaliação de Programas e Projetos de Saúde , Fatores de Risco , Comportamento Sexual , Abuso de Substâncias por Via Intravenosa/complicaçõesRESUMO
Clients in a community-based methadone treatment program earned stars for attending counseling sessions as scheduled and for providing clean urines. These stars were later redeemed for contingent rewards (food or gas coupons or bus tokens) according to one of three randomly assigned reward schedules, including high reward (four stars per prize), low reward (eight stars per prize), or delayed reward (those who had to wait 3 months to earn a prize). Clients in the high-reward condition showed a pattern of increasing the number of stars earned for group sessions and clean urines across the 3-month intervention. All clients, independent of reward condition, attended significantly more group counseling sessions during the months that contingent reinforcers were available than in the months prior to, and after, the intervention. Finally, urinalysis data indicated that, in the postintervention period, high-reward clients had fewer dirty urines than did low-reward or delayed-reward clients. This study suggests that a simple system of recognizing client progress with stars and modest prizes for performing specific behaviors can be an effective tool in increasing clinic attendance rates and reducing positive urines.
Assuntos
Terapia Comportamental/métodos , Dependência de Heroína/reabilitação , Metadona/uso terapêutico , Cooperação do Paciente , Recompensa , Centros de Tratamento de Abuso de Substâncias , Adulto , Idoso , Análise de Variância , Aconselhamento , Feminino , Dependência de Heroína/urina , Humanos , Masculino , Pessoa de Meia-Idade , Esquema de Reforço , Reforço por Recompensa , Resultado do TratamentoRESUMO
Tenure in methadone maintenance treatment was analyzed in terms of treatment process factors using a survival curve regression analysis. The treatment process framework included client variables at entry, program characteristics, treatment events, and client attitudes and satisfaction. The sample consisted of 606 methadone maintenance clients from 21 different clinics. Significant predictors included professional classifications of the diagnosing and treatment-planning staff members, measures of early treatment services, client attitudes and satisfaction, methadone dosage level, and frequency of urine monitoring. The results showed higher tenure rates when specialized professionals diagnosed problems and defined treatment plans, when service needs were addressed, when client attitudes and satisfaction were high, and when methadone dose was higher. Lower tenure rates were found among blacks and clients with lower sociodemographic status. Lower tenure also occurred among those who perceived the program as less accessible or less structured in its procedures.
Assuntos
Metadona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/reabilitação , Pacientes Desistentes do Tratamento/psicologia , Negro ou Afro-Americano/psicologia , Cuidado Periódico , Seguimentos , Dependência de Heroína/psicologia , Dependência de Heroína/reabilitação , Humanos , Tempo de Internação/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/psicologia , Cooperação do Paciente/psicologia , Análise de Regressão , Fatores SocioeconômicosRESUMO
The role of drug availability and psychological proneness in opioid addiction was examined using longitudinal data from the Drug Abuse Reporting Program (DARP). The sample included 424 addicts who were followed up and interviewed approximately 12 years after admission to treatment in the DARP, and for whom admission, during-treatment, and 6-year follow-up data were also available. Drug availability and proneness were both found to be important for drug use at any given time--from initial stages of addiction as well as in Year 12 of the follow-up--but proneness was rated as relatively more important for opioid use in the later stages of the addiction career. Proneness measures contributed more to the prediction of long-term drug use outcomes.
Assuntos
Drogas Ilícitas/provisão & distribuição , Metadona/uso terapêutico , Entorpecentes/provisão & distribuição , Transtornos Relacionados ao Uso de Opioides/reabilitação , Meio Social , Adulto , Assistência Ambulatorial/psicologia , Feminino , Seguimentos , Heroína/provisão & distribuição , Dependência de Heroína/psicologia , Dependência de Heroína/reabilitação , Hospitalização , Humanos , Masculino , Transtornos Relacionados ao Uso de Opioides/psicologia , Comunidade TerapêuticaRESUMO
Follow-up interviews on a sample of 298 ex-heroin addicts 12 years after they entered treatment were used to examine alcohol use and substitution of alcohol for heroin. Almost one-fourth of the sample were classified as heavy drinkers in Year 12, and half had previously used alcohol in a substitution pattern. Classifications into one of three substitution groups (none, low and high) and multivariate analysis of variance were carried out to identify background and baseline factors related to substitution and long-term behavioral outcomes 12 years after entering treatment. Substitution was found to be related to higher levels of alcohol problems and treatment before addiction, parental alcohol problems, to vulnerability to peer influence in starting drug use and to feelings of rejection by peers during adolescence. In terms of 12-year outcomes, substitution was related to more use of nonopioid drugs, more heavy drinking and alcohol-related problems and more psychological dysfunction symptoms (such as depression). These results showed a strong relationship between substitution and preaddiction as well as postaddiction alcohol abuse. However, to delineate the effects of substitution apart from the effects of previous alcohol abuse, additional analyses were computed in which substitution was examined after controlling for previous alcohol abuse. The results confirmed the validity of substitution as a powerful construct in identifying behavioral differences before and after addition.
Assuntos
Alcoolismo/reabilitação , Dependência de Heroína/reabilitação , Adulto , Consumo de Bebidas Alcoólicas/psicologia , Alcoolismo/complicações , Alcoolismo/psicologia , Terapia Combinada , Feminino , Seguimentos , Dependência de Heroína/complicações , Dependência de Heroína/psicologia , Humanos , Masculino , Problemas SociaisRESUMO
Long-term behavioral outcome status of 990 daily opioid users, recorded in follow-up interviews about six years after admission to community-based treatment programs, was classified in terms of longitudinal patterns of opioid use. Sixty-one percent of these individuals had achieved abstinence from opioid drugs for a year or longer immediately before the follow-up interview. Compared with those who continued heavy opioid drug use, and with others who had problems with nonopioid drugs or alcohol over time, persons who achieved abstinence also had significantly better long-term outcomes on criminality, use of nonopioid drugs and alcohol, and productive activities. Except for criminal history, outcome status was generally unrelated to client demographic and background predictors, but behavioral improvements over time were strongly associated with participation in drug abuse treatment.
Assuntos
Serviços Comunitários de Saúde Mental , Transtornos Relacionados ao Uso de Opioides/terapia , Adulto , Alcoolismo/complicações , Assistência Ambulatorial , Feminino , Seguimentos , Dependência de Heroína/complicações , Dependência de Heroína/reabilitação , Dependência de Heroína/terapia , Humanos , Masculino , Abuso de Maconha/complicações , Metadona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/complicações , Transtornos Relacionados ao Uso de Opioides/reabilitação , Avaliação de Processos e Resultados em Cuidados de Saúde , Controle Social Formal , Comunidade TerapêuticaAssuntos
Etnicidade , Dependência de Heroína/reabilitação , Metadona/uso terapêutico , Comportamento Social , Adulto , Negro ou Afro-Americano , Alcoolismo/epidemiologia , Crime , Emprego , Feminino , Seguimentos , Hispânico ou Latino , Humanos , Masculino , Fatores Sexuais , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , População BrancaRESUMO
Twenty-six persons participated in a community smoking program, which required a $40 contribution to the sponsoring health organization and a $25 refundable deposit. Clients were assigned to one of two treatment groups; one involved group discussion and rapid puffing, and the other involved group discussion only. The number of cigarettes smoked before treatment and one week, two months, and five months after treatment were determined for each client. Smoking decreased substantially following treatment in both groups and did not differ significantly between the groups across the follow-up periods. Females, however, showed significantly greater relapse in smoking following treatment than did males. Overall, approximately 15% of the clients in each group were abstinent five months after treatment.
Assuntos
Avaliação de Processos e Resultados em Cuidados de Saúde , Prevenção do Hábito de Fumar , Instituições Filantrópicas de Saúde , Adulto , Terapia Comportamental , Serviços Comunitários de Saúde Mental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Fumar/psicologia , TexasRESUMO
Patient characteristics are described in relation to pretreatment usage combinations of eight classes of illicit drugs for 11,380 drug abusers admitted between 1969 and 1971 to drug treatment centers participating in the NIDA-TCU Drug Abuse Reporting Program. From these data, nine basic patterns of drug use were defined. The most frequent, involving the daily use of heroin or other opioids only, characterized 27% of the patients. Four patterns involving heroin (at least weekly) with various combinations of cocaine, barbiturates, and marijuana accounted for another 29%, two patterns of polydrug use (three or more nonopioid drugs, with and without opioids daily) included 16%, and the remaining 28% of the patients were represented by patterns of a less specific nature. The distribution of patients across drug-use patterns was unrelated to sex, but was associated with race-ethnic background and age.