On beyond urine: clinically useful assessment instruments in the treatment of drug dependence.

Although there are a wealth of clinically useful, brief, and low-cost assessment instruments available for use with drug-dependent populations, relatively few are broadly used in clinical practice. With an emphasis on: (1). the multidimensional nature of drug users' problems; and (2). assessments that can be integrated into empirically validated treatments, clinically useful assessments in four general categories (evaluation and diagnosis of drug dependence, identifying concurrent disorders and problems, treatment planning, and evaluation of treatment outcome) are briefly summarized. Progress in the field of drug abuse treatment has been significantly hampered by the failure to adopt, across research and clinical settings, a common set of assessments.

Day treatment versus enhanced standard methadone services for opioid-dependent patients: a comparison of clinical efficacy and cost.

OBJECTIVE: This study examined the differential efficacy and relative costs of two intensities of adjunctive psychosocial services--a day treatment program and enhanced standard care--for the treatment of opioid-dependent patients maintained on methadone hydrochloride. METHOD: A 12-week randomized clinical trial with 6-month follow-up was conducted in a community-based methadone maintenance program. Of the 308 patients who met inclusion criteria, 291 began treatment (day treatment program: N=145; enhanced standard care: N=146), and 237 completed treatment (82% of those assigned to the day treatment program and 81% of those receiving enhanced standard care). Two hundred twenty of the patients participated in the 6-month follow-up (75% of those in the day treatment program and 73% of those in enhanced standard care provided a follow-up urine sample for screening). Both interventions were 12 weeks in duration, manual-guided, and provided by master's-level clinicians. The day treatment was an intensive, 25-hour-per-week program. The enhanced standard care was standard methadone maintenance plus a weekly skills training group and referral to on- and off-site services. Outcome measures included twice weekly urine toxicology screens, severity of addiction-related problems, prevalence of HIV risk behaviors, and program costs. RESULTS: Although the cost of the day treatment program was significantly higher, there was no significant difference in the two groups' use of either opiates or cocaine. Over the course of treatment, drug use, drug-related problems, and HIV risk behaviors decreased significantly for patients assigned to both treatment intensities. Improvements were maintained at follow-up. CONCLUSIONS: Providing an intensive day treatment program to unemployed, inner-city methadone patients was not cost-effective relative to a program of enhanced methadone maintenance services, which produced comparable outcomes at less than half the cost.

Predictors of 2.5-year outcome in opioid addicts: pretreatment source of income.

A recent 6-month follow-up of methadone maintenance (MM) suggested that addicts supported by public assistance before seeking MM have a globally poor prognosis compared to addicts supported by employment or illegal activities. We therefore examined 2.5-year outcome among addicts prognostically stratified by three major sources of pretreatment income: employment (n = 48), welfare (n = 46), and criminal activities (n = 57). Significant improvements in substance abuse, family, legal, and psychological problems were reported by all three groups. Furthermore, the welfare group showed the most improvement in medical status and on the Social Adjustment, Maudsley neuroticism, and Beck Depression scales. Thus, the welfare patients did not appear to have a globally poorer prognosis, although they showed the least improvement in employment and legal problems. To examine whether welfare patients on MM had no more than "expected" improvement in legal and employment problems, patients treated with MM (n = 83) were compared to those getting only detoxification (DT) (n = 40). Welfare patients showed no more improvement in these two areas from MM treatment than from DT alone, while at follow-up the "employed" and "criminal" groups had substantially less illegal income and unemployment with MM than with DT alone. Thus, welfare patients may do relatively poorly in some areas when treated on MM.

Selecting psychotherapists to participate in psychotherapy outcome studies. Relationship between psychotherapist characteristics and assessment of clinical skills.

The procedures developed for assessing specific psychotherapist skills are described, and the relationships among judges' ratings of these skills and selected therapist characteristics are examined and discussed. Data for 27 therapist applicants indicate a positive relationship between overall ratings of therapist skill and the age and level of experience of the psychotherapist applicants, with older, more experienced therapists being judged as more empathic and having greater potential to function effectively in short term interpersonal psychotherapy. In contrast, psychotherapists' gender and professional degree failed to predict judges' ratings.