Therapy preference and treatment outcome in clients with mild to moderate alcohol dependence.

The Brief Treatment Programme for Alcohol Dependence allocated 122 clients randomly to three different forms of brief therapy. Prior to allocation clients were asked what their preference would have been had allocation not been random. This study posed the question: did clients receiving their preferred treatment have a better outcome than those who did not? Also examined were differences in the treatment process variables of perceived effectiveness, satisfaction, rapport, engagement and number of sessions attended. The results were that there was no difference in either outcome or treatment process according to whether or not clients were allocated to their treatment of preference. It is concluded that these findings reinforce both the ethicality of the randomized controlled trial as a methodology for examining differential treatment outcomes in individual brief treatment of between one and five sessions for alcohol dependence and the validity of these findings as they might relate to real clinical settings. Finally, it is suggested that other researchers consider the inclusion of questions related to client preference.

Health status of clients receiving methadone maintenance treatment using the SF-36 health survey questionnaire.

This study investigated the health status of a representative sample of clients (35 Maori, 72 non-Maori) receiving methadone maintenance treatment in New Zealand, using the SF-36 health survey. The publication of New Zealand norms in 1999 enabled comparisons of the health of the Methadone Treatment Programme study participants with that of the New Zealand population. Although over 50% of participants rated their health as good, very good or excellent, 44% rated their health as fair or poor and compared with population norms, the health of the study participants was significantly poorer on all eight SF-36 scales. Male and female participants rated their health similarly to male and female clients attending another New Zealand Methadone Treatment Programme. Results highlighted the impact of a chronic disorder and co-existing health-related problems on the health and well-being and day-to-day functioning of this client group. Higher frequency of benzodiazepine use was associated with poorer social functioning, mental health and role functioning and higher frequency of cannabis use was associated with poorer role functioning due to emotional problems. Findings support routine monitoring of health status with clients receiving methadone maintenance treatment as a guide to preventative and treatment interventions and health maintenance strategies.

Reduction in crime by drug users on a methadone maintenance therapy programme in New Zealand.

AIM: The study aimed to estimate changes in drug use, crime, imprisonment and societal costs among a sample of Maori and non-Maori injecting drug users (IDUs) on a methadone maintenance therapy (MMT) programme in Christchurch, New Zealand. METHODS: Fifty-one non-Maori and 34 Maori IDUs were interviewed to obtain a self-reported history of drug use, crime, imprisonment, and effects on personal health. Information was obtained on drug use and crime before starting MMT and also after stabilisation on MMT. Follow-up interviews were conducted 18 months (mean) after the first interview. RESULTS: Considerable reductions in the frequency of crime occurred--with 60% of participants reporting they committed crimes every day before MMT, compared with only 1% at interview. Large reductions were reported in both expenditure on illicit drugs and income from illegal activities. Reductions in opioid use and crime were similar for both Maori and non-Maori. A significant minority of participants reported continuing some form of crime while on MMT; 29% reported committing at least one offence during the week prior to interview. CONCLUSIONS: MMT is associated with a large reduction in the costs of crime and imprisonment among IDUs. This reduction in crime is similar for both Maori and non-Maori.

Association of a duplicated repeat polymorphism in the 5'-untranslated region of the DRD4 gene with novelty seeking.

Novelty Seeking (NS) is a human personality trait in which impulsive, exploratory, and thrill-seeking behaviors are displayed. Dopaminergic genes have been prime candidates in the search for the genetic factors underlying NS because of the central role that dopamine plays in the brain's reward system. We have investigated whether there is an association between a polymorphic 120 base pairs (bp) repeat that is located in the 5'-untranslated region of the dopamine D4 receptor gene (DRD4) and NS. We genotyped four separate groups from psychiatric clinical studies for the repeat polymorphism. There were significant associations with NS in the groups of bipolar (P = 0.01) and alcoholic (P = 0.006) families containing 267 and 172 subjects, respectively. Subjects who were homozygous for the single-copy allele (SS genotype) had higher mean NS scores. This trend was also observed in the two other studies that contained unrelated subjects diagnosed with depression (N = 143 and N = 148) but the associations between DRD4 duplication genotype and NS were not significant in these groups. In the data combined from all four clinical groups those genotyped as SS had higher mean scores for all four NS subscales with significant associations for impulsivity (P = 0.0006), extravagance (P = 0.04), disorderliness (P = 0.02), and total NS (P = 0.0003). However, given the low frequency of the single-copy allele, this polymorphism would account for only a small proportion of the variance of NS in the population.