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1.
Ann Surg Oncol ; 18(4): 997-1005, 2011 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-21042941

RESUMEN

BACKGROUND: Besides tumor characteristics, colorectal cancer (CRC) outcomes are also determined by host factors, in particular the systemic inflammatory response. The basis of this relationship with survival is not known; however, systemic inflammation may reflect comorbidity. The present study examines relationships between host factors (including age, comorbidity, deprivation, and systemic inflammation) and survival in CRC. METHODS: A total of 302 patients underwent curative elective CRC resection between 1997 and 2005. Data was collected on patient comorbidity (Charlson Comorbidity Index [CCI], Lee Cardiac Risk Index [LCRI], National Institute on Aging and National Cancer Institute Comorbidity Index [NIA/NCI], and Adult Comorbidity Evaluation-27 [ACE-27]), systemic inflammatory response (Glasgow Prognostic Score [mGPS]), deprivation [Carstairs Deprivation Index], body mass index, and smoking status. RESULTS: For cancer-specific survival, age (P = 0.047), tumor, node, metastasis system stage (P < 0.001), high-risk Petersen Index (P < 0.001), LCRI (P = 0.021), and mGPS (P < 0.001) were independent factors by multivariate analysis. For overall survival, age (P < 0.001), tumor, node, metastasis system stage (P = 0.001), high-risk Petersen Index (P = 0.002), postoperative infective complications (P = 0.002), ACE-27 (P = 0.008), and mGPS (P < 0.001) were independent factors. Older age related to increasing comorbidity (ACE-27, CCI, LCRI [P < 0.005]) and increased mGPS (P < 0.005). Smoking and deprivation related to increasing comorbidity (P < 0.05). The mGPS was associated with high comorbidity burden assessed with ACE-27 (P = 0.065), CCI (P = 0.016), LCRI (P = 0.095), and NIA/NCI (P = 0.084). CONCLUSIONS: Comorbidity does not fully explain the relationship between the mGPS and cancer-specific survival in CRC patients. Furthermore, comorbidity, in particular that measured by the LCRI, is an important independent indicator of cancer survival.


Asunto(s)
Neoplasias Colorrectales/cirugía , Inflamación/cirugía , Recurrencia Local de Neoplasia/cirugía , Complicaciones Posoperatorias , Anciano , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/patología , Comorbilidad , Femenino , Estudios de Seguimiento , Humanos , Inflamación/mortalidad , Inflamación/patología , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Periodo Preoperatorio , Estudios Prospectivos , Tasa de Supervivencia , Resultado del Tratamiento
2.
AIDS ; 10(14): 1719-28, 1996 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-8970693

RESUMEN

OBJECTIVE: To evaluate the hypothesis that long-term methadone detoxification would produce greater HIV risk reduction among injecting drug users (IDU) than short-term detoxification. DESIGN: Random assignment to 21 or 90 days of free detoxification. SETTING: Storefront offices in two cities, with referrals to outpatient methadone detoxification. PARTICIPANTS: Out-of-treatment IDU (n = 1803), recruited through street outreach and word of mouth, between April 1990 and March 1991. Of these, 62.6% were successfully located for 6-month follow-up. MAIN OUTCOME MEASURES: Self-reported drug injection and sexual practices at baseline and follow-up. RESULTS: Substantial reductions in risk behavior were observed at follow-up. Substantial percentages of subjects reported less frequent drug injection (54%), use of shooting galleries (85%), needle-sharing (67%), and number of sex partners (73%), and more frequent use of bleach to disinfect needles (67%) and condom use (31%). There were no significant differences in behavioral change between 21 and 90-day treatment, and subjects who entered treatment did not report significantly greater risk reduction than untreated subjects. Discriminant analyses showed a marginal effect for duration of treatment on risk reduction, although results were inconsistent. CONCLUSIONS: Large scale behavioral risk reduction appears to be occurring in this population regardless of treatment condition. In minimal service methadone detoxification, subjects treated under a longer-term detoxification protocol demonstrated no greater risk reduction than those receiving short-term detoxification.


Asunto(s)
Analgésicos Opioides/administración & dosificación , Infecciones por VIH/prevención & control , Metadona/administración & dosificación , Asunción de Riesgos , Abuso de Sustancias por Vía Intravenosa , Trastornos Relacionados con Sustancias/rehabilitación , Estudios de Seguimiento , Infecciones por VIH/etiología , Humanos , Factores de Tiempo
3.
Am J Psychiatry ; 132(12): 1295-9, 1975 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-1200174

RESUMEN

Small-group workshops of nonevaluators with differing interests in mental health discussed evaluation priorities for community mental health centers. Participants included center professionals, concerned citizens, and funders. A majority of the participants placed high value on accountability from a consumer standpoint and relatively low value on center management issues and cost or equity of service delivery. Center staff were more interested in efficiency and effectiveness, while outsiders with vested interests were more concerned with community involvement. The authors summarize seven role perspectives and discuss their implications for the establishment of evaluation priorities within a center.


Asunto(s)
Servicios Comunitarios de Salud Mental/normas , Actitud Frente a la Salud , Atención a la Salud/normas , Estudios de Evaluación como Asunto , Organización y Administración , Defensa del Paciente , Pennsylvania
4.
Am J Psychiatry ; 148(5): 636-40, 1991 May.
Artículo en Inglés | MEDLINE | ID: mdl-2018166

RESUMEN

OBJECTIVE: This paper examines the sociodemographic and psychiatric characteristics of patients taking methadone who continue to share needles. METHOD: Three hundred twenty-three patients were recruited from four methadone programs. Data were collected by using questionnaires and interviews. Psychiatric symptoms were measured with the SCL-90, the Beck Depression Inventory, and the Addiction Severity Index. RESULTS: Twenty percent of these subjects reported sharing needles within the previous 6 months. Those who shared reported greater difficulty in acquiring new needles, more legal difficulties, more severe drug problems, and higher levels of psychiatric symptoms. CONCLUSIONS: These data suggest that patients who continue to share needles are a more disturbed subgroup of the methadone maintenance population. Efforts designed to reduce needle sharing may need to be more sharply focused on patients who are at greatest risk of infection, and these patients may require more intensive psychiatric services.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/transmisión , Metadona/uso terapéutico , Agujas , Abuso de Sustancias por Vía Intravenosa/psicología , Atención Ambulatoria , Contaminación de Equipos , Humanos , Inventario de Personalidad , Escalas de Valoración Psiquiátrica , Factores de Riesgo , Índice de Severidad de la Enfermedad , Estrés Psicológico/diagnóstico , Estrés Psicológico/psicología , Abuso de Sustancias por Vía Intravenosa/complicaciones , Abuso de Sustancias por Vía Intravenosa/rehabilitación
5.
J Acquir Immune Defic Syndr (1988) ; 7(5): 491-9, 1994 May.
Artículo en Inglés | MEDLINE | ID: mdl-8158544

RESUMEN

A total of 4,375 subjects were recruited through continuous street outreach over 31 months for interviews on HIV-related risk behavior and HIV-antibody testing. Changes over time among sampled subjects with respect to HIV infection and HIV-risk behavior have been examined retrospectively, and significant and consistent trends noted across successive cohorts. Although overall 42% of the sample tested HIV antibody-positive, HIV infection exhibited a consistent downward trend from 60% in the first quarter year of interviewing to 22% in the final quarter year. Scores on a multivariate index of HIV risk also declined significantly. Mean age, proportion of Black subjects, mean length of drug injection career, frequency of drug injection, and the use of shooting galleries all declined significantly across quarters as well. We argue that these observed differences result from a systematic sampling bias inherent in our outreach-driven sampling procedures, which initially favored recruitment of IDUs with greater behavioral and demographic risk for HIV.


Asunto(s)
Infecciones por VIH/epidemiología , Seroprevalencia de VIH , Abuso de Sustancias por Vía Intravenosa/complicaciones , Adulto , Negro o Afroamericano , Factores de Edad , Análisis de Varianza , Estudios de Cohortes , Recolección de Datos/métodos , Interpretación Estadística de Datos , Femenino , Infecciones por VIH/etnología , Infecciones por VIH/etiología , Conductas Relacionadas con la Salud , Hispánicos o Latinos , Humanos , Masculino , Análisis Multivariante , New Jersey/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Abuso de Sustancias por Vía Intravenosa/epidemiología , Abuso de Sustancias por Vía Intravenosa/etnología
6.
Psychol Bull ; 117(3): 416-33, 1995 May.
Artículo en Inglés | MEDLINE | ID: mdl-7777647

RESUMEN

Employment has been identified as an important element in the rehabilitation of drug abusers and, together with abstinence from illicit drugs and criminal involvement, is frequently used as a criterion of treatment outcome. The research literature for the last 20 years on variables affecting employment and the vocational rehabilitation of drug abusers is reviewed with an emphasis on (a) the identification of variables influencing the employment of drug abusers and (b) the evaluation results of interventions that have been developed for this purpose. It is concluded that a number of programs have been demonstrated to have had some success in the vocational rehabilitation of drug abusers. Specific recommendations are made concerning both the direction of further research in this area and the application of existing knowledge in current practice.


Asunto(s)
Rehabilitación Vocacional , Trastornos Relacionados con Sustancias/rehabilitación , Empleo , Humanos
7.
Science ; 152(3722): 591, 1966 Apr 29.
Artículo en Inglés | MEDLINE | ID: mdl-17779485
8.
Addiction ; 90(9): 1241-52, 1995 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-7580821

RESUMEN

We interviewed 265 cocaine-experienced methadone patients about situations that occasioned their cocaine use and strategies they used to avoid cocaine use. Subjects identified an average of 15 situations that occasioned cocaine use. The three most frequently identified were having the drug present (86% of subjects), being offered the drug (85%) and having money available (83%). Subjects reporting fewer situations also reported longer periods of lifetime abstinence (p < 0.01). A principal components analysis extracted 10 groups of situations that were most frequently identified in combination. Subjects identified a median of seven strategies for avoiding cocaine use; however, there was large inter-subject variability. This variance was not accounted for by demographic variables, employment status or treatment experience. The three strategies identified most frequently were avoiding people and places (81%), thinking about what they could lose (76%) and leaving the situation (66%). The total number and type (reactive vs. proactive) of strategies identified by subjects had no relationship to cocaine abstinence, although four specific strategies (thinking about what could be lost, leaving the situation, moving to a new area and using a different drug) were positively correlated with cocaine abstinence. We discuss implications of these results for clinical practice.


Asunto(s)
Cocaína , Motivación , Facilitación Social , Trastornos Relacionados con Sustancias/psicología , Adulto , Femenino , Dependencia de Heroína/psicología , Dependencia de Heroína/rehabilitación , Humanos , Control Interno-Externo , Masculino , Metadona/uso terapéutico , Persona de Mediana Edad , Medio Social , Centros de Tratamiento de Abuso de Sustancias , Trastornos Relacionados con Sustancias/rehabilitación
9.
J Consult Clin Psychol ; 66(5): 761-7, 1998 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-9803694

RESUMEN

This study examined whether voucher delivery arrangements affect treatment outcome. First, 90 cocaine-dependent adults were randomly assigned to behavioral counseling or counseling plus vouchers for cocaine-free urine samples. The value of each voucher was low at the beginning but increased as the patient progressed (Voucher Schedule 1). Voucher Schedule 1 produced no improvements relative to counseling only. Next, 23 patients received vouchers on either Voucher Schedule 1 or Voucher Schedule 2. Voucher Schedule 2 began with high voucher values, but requirements for earning vouchers increased as the patient progressed. Average durations of cocaine abstinence were 6.9 weeks on Voucher Schedule 2 versus 2.0 weeks on Voucher Schedule 1 (p = .02). This confirms that vouchers can assist in initiating abstinence and that voucher delivery arrangements are critical.


Asunto(s)
Terapia Conductista , Trastornos Relacionados con Cocaína/terapia , Esquema de Refuerzo , Régimen de Recompensa , Adulto , Análisis de Varianza , Terapia Conductista/métodos , Terapia Conductista/normas , Distribución de Chi-Cuadrado , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Detección de Abuso de Sustancias/psicología , Análisis de Supervivencia , Resultado del Tratamiento
10.
J Consult Clin Psychol ; 64(1): 221-4, 1996 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-8907102

RESUMEN

This study examined self-reported dysphoria in 82 consecutive admissions to intensive outpatient treatment for cocaine abuse on whom data for the Beck scales for depression, anxiety, and hopelessness were available for intake and 4 subsequent weeks with no more than 1 missing data point. Mean scores on the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) decreased significantly between intake and Week 1, with no further significant changes from Weeks 1-4. Similar drops in the rate of clinically significant BDI and BAI scores also were observed. Scores on the Beck Hopelessness Scale (BHS) showed no significant changes. By Week 4, rates of clinically significant depression, anxiety, and hopelessness were similar (17%, 13%, and 16%, respectively). These findings suggest that assessing depression and anxiety using the BDI and BAI in this population should be postponed for at least 1 week after intake and that intake levels of self-reported mood may be inappropriate baseline measures for evaluating treatment effects.


Asunto(s)
Trastornos de Ansiedad/diagnóstico , Cocaína , Trastorno Depresivo/diagnóstico , Trastornos Relacionados con Sustancias/rehabilitación , Población Urbana , Adulto , Atención Ambulatoria , Trastornos de Ansiedad/psicología , Comorbilidad , Trastorno Depresivo/psicología , Femenino , Humanos , Masculino , Motivación , Admisión del Paciente , Inventario de Personalidad , Trastornos Relacionados con Sustancias/psicología
11.
Drug Alcohol Depend ; 34(2): 99-103, 1994 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-8026306

RESUMEN

The Beck Hopelessness Scale (BHS) was administered to 2379 intravenous drug users who were not in treatment, unaware of their human-immunodeficiency-virus (HIV) status and seeking HIV testing and counselling. Three BHS principal components were identified reflecting resignation to the futility of changing the future, rejection of the possibility of a hopeful future, and acceptance of the inevitability of a hopeless future. The principal component scores representing these three dimensions were positively related to self-reported depression and suicidal ideation; the rejection scores were positively correlated with confirmed HIV seropositivity.


Asunto(s)
Serodiagnóstico del SIDA/psicología , Consejo , Depresión/psicología , Motivación , Abuso de Sustancias por Vía Intravenosa/psicología , Adaptación Psicológica , Adulto , Cocaína , Depresión/diagnóstico , Femenino , Seropositividad para VIH/psicología , Dependencia de Heroína/psicología , Humanos , Masculino , Inventario de Personalidad , Factores de Riesgo , Rol del Enfermo , Trastornos Relacionados con Sustancias/psicología , Suicidio/psicología , Prevención del Suicidio
12.
Drug Alcohol Depend ; 26(2): 117-25, 1990 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-2242713

RESUMEN

Relatively few methadone programs emphasize vocational skills training in their service delivery protocols. As a result, this study was conducted to determine the contribution of background demographic, vocational and clinical characteristics in differentiating chronically unemployed methadone clients from those regularly or intermittently employed over a 3-year period of time. Three-hundred eighty heroin addicts, from five urban methadone treatment programs, participated in the study. Using the multiple logistic regression approach, nine variables were found to be significantly related to unemployment risk.


Asunto(s)
Dependencia de Heroína/rehabilitación , Metadona/uso terapéutico , Rehabilitación Vocacional/psicología , Desempleo/psicología , Adulto , Femenino , Humanos , Masculino , Recurrencia , Factores de Riesgo
13.
Drug Alcohol Depend ; 24(3): 175-81, 1989 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-2605992

RESUMEN

One-hundred Dutch and 100 American heroin addicts receiving methadone were administered the Symptom Check List-90 (SCL-90), and a Modal Profile Analysis was performed to determine whether or not the mean profiles of the nine SCL-90 subscales were comparable for these two White male samples. Three profile-shape components correctly classified over 85% of both groups and reflected (1) Anxious-depressed, (2) Hostile and (3) Paranoid syndromes. The relationships of the SCL-90 profiles to selected psychosocial characteristics were also studied. For example, marijuana use was associated with the Paranoid shape component in both samples. The implications of these SCL-90 profiles for identifying common aspects of self-reported psychopathology in both Dutch and American heroin addicts were discussed.


Asunto(s)
Dependencia de Heroína/psicología , Adulto , Trastornos de Ansiedad/psicología , Trastorno Depresivo/psicología , Hostilidad , Humanos , Masculino , Países Bajos , Conducta Paranoide/psicología , Estados Unidos , Población Blanca
14.
Drug Alcohol Depend ; 40(1): 63-71, 1995 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-8746926

RESUMEN

Data on 3016 out-of-treatment injecting drug users (IDUs) were analyzed in order to replicate findings from an earlier study on risk factors for HIV infection (Iguchi et al., 1992) and evaluate a model for estimating probability of infection. Logistic regression analyses yielded a set of risk factors highly consistent with previous findings. A logistic function was used to estimate subjects' probabilities of infection, and these estimates were strongly correlated with actual HIV prevalence in both the original and current samples. The current study represents a successful replication of earlier findings and supports the validity of the risk model.


Asunto(s)
Seropositividad para VIH/transmisión , Abuso de Sustancias por Vía Intravenosa/epidemiología , Adulto , Femenino , Seroprevalencia de VIH , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , New Jersey/epidemiología , Probabilidad , Estudios Prospectivos , Reproducibilidad de los Resultados , Riesgo , Abuso de Sustancias por Vía Intravenosa/rehabilitación
15.
Drug Alcohol Depend ; 42(2): 77-84, 1996 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-8889406

RESUMEN

This paper reports preliminary data derived from a standardized interview scoring procedure for detecting and characterizing coercive and noncoercive pressures to enter substance abuse treatment. Coercive and noncoercive pressures stemming from multiple psychosocial domains are operationalized through recourse to established behavioral principles. Inter-rater reliability for the scoring procedure was exceptional over numerous rater trials. Substantive analyses indicate that, among clients in outpatient cocaine treatment, 'coercion' is operative in multiple psychosocial domains, and that subjects perceive legal pressures as exerting substantially less influence over their decisions to enter treatment than informal psychosocial pressures. Implications for drug treatment planning, legal and ethical issues, and directions for future research are proposed.


Asunto(s)
Coerción , Internamiento Obligatorio del Enfermo Mental/legislación & jurisprudencia , Aceptación de la Atención de Salud , Determinación de la Personalidad/estadística & datos numéricos , Trastornos Relacionados con Sustancias/rehabilitación , Adulto , Alcoholismo/psicología , Alcoholismo/rehabilitación , Atención Ambulatoria/legislación & jurisprudencia , Cocaína , Comorbilidad , Cocaína Crack , Ética Médica , Femenino , Humanos , Masculino , Abuso de Marihuana/psicología , Abuso de Marihuana/rehabilitación , Persona de Mediana Edad , Motivación , Trastornos Relacionados con Opioides/psicología , Trastornos Relacionados con Opioides/rehabilitación , Psicometría , Reproducibilidad de los Resultados , Control Social Formal , Controles Informales de la Sociedad , Trastornos Relacionados con Sustancias/psicología , Resultado del Tratamiento
16.
Soc Sci Med ; 28(1): 1-8, 1989.
Artículo en Inglés | MEDLINE | ID: mdl-2648592

RESUMEN

This paper reviews the literature on AIDS in Africa. By 29 February, 1988, 9760 cases of AIDS had been reported in Africa. This review addresses the currently accepted belief in the African origin of AIDS, the distribution (cluster) of AIDS in Africa, identified modes of transmission, and changing sexual and drug use behaviors in Africa. There is no conclusive evidence to show that the AIDS virus originated in Africa. Even if the progenitor virus had a habitat in central Africa, certain high-risk sexual behaviors which were introduced in the 60s and 70s may have initiated the infectious process. The distribution pattern does not suggest a transcontinental spread; rather, it suggests a contigual and transatlantic spread. The primary mode of transmission is heterosexual activity. This paper raises a number of questions relating to heterosexual behaviors. Other issues addressed include drug use behavior, homosexuality, and high-risk sexual activities of Africans and foreigners in Africa. Other modes of transmission are transfusion of contaminated blood and blood products, use of nonsterile needles, and perinatal transmission. It is not likely that traditional (folk) medicine will contribute to the spread of AIDS. Traditional doctors use fresh razor blades for cuts and not hollow instruments such as needles. The impact of the political and socioeconomic climate in most of Africa during the 60s and early 70s is evaluated. Finally, we make suggestions for future direction, which include confirmatory testing of HIV Positive samples, conducting clinical epidemiology and social science-based research, and developing innovative education programs that are culturally relevant.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/transmisión , África , Humanos , Conducta Sexual , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/epidemiología
17.
J Pers Disord ; 11(2): 177-90, 1997.
Artículo en Inglés | MEDLINE | ID: mdl-9203112

RESUMEN

The study compared structured interview (SCID-II) and self-report test (MCMI-II) vantages for the detection and characterization of personality pathology among 144 urban, poor, cocaine-addicted individuals seeking outpatient treatment. Diagnostic agreement was inadequate for most disorders, and the instruments at best shared only modest common variance. Positive predictive power was poor for all MCMI-II scales, though negative predictive power was good to excellent. This lends support for the use of the MCMI-II as a screening measure to rule out Axis II disorders; however, confirmation of positive diagnoses will require follow-up interview assessment. Future development of self-report personality inventories for substance abusers should focus on controlling for the acute dysphoric effects of drug use and related dysfunction, expanding attention to Cluster B content domains, and incorporating more objective criteria for assessing paranoia and "odd/eccentric" traits.


Asunto(s)
Cocaína , Determinación de la Personalidad/estadística & datos numéricos , Trastornos de la Personalidad/diagnóstico , Inventario de Personalidad/estadística & datos numéricos , Trastornos Relacionados con Sustancias/psicología , Adulto , Atención Ambulatoria , Femenino , Personas con Mala Vivienda/psicología , Humanos , Masculino , Persona de Mediana Edad , New Jersey , Trastornos de la Personalidad/clasificación , Trastornos de la Personalidad/psicología , Pobreza/psicología , Psicometría , Reproducibilidad de los Resultados , Trastornos Relacionados con Sustancias/rehabilitación
18.
J Subst Abuse Treat ; 14(1): 29-35, 1997.
Artículo en Inglés | MEDLINE | ID: mdl-9218234

RESUMEN

Although methadone maintenance is an effective treatment for opiate addiction, variations in treatment outcome are evident. These variations may be explained in part by the rehabilitative experiences of patients as reflected in their use of collateral services. This study examined service involvement of 409 methadone maintenance patients at four clinics in order to identify the types of services used and the extent to which potentially rehabilitative services were used. Aside from welfare, there was a strikingly low level of service utilization. Even when services were used, the levels of this use were so low as to be virtually ineffective. These findings regarding treatment and social service utilization suggest that there may not be any attempt to match service provision with patient needs for services. A more rational approach to matching patient needs and available services is thus called for.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Servicios de Salud Comunitaria/estadística & datos numéricos , Metadona/uso terapéutico , Trastornos Relacionados con Opioides/rehabilitación , Servicio Social , Adulto , Análisis de Varianza , Humanos , Resultado del Tratamiento , Estados Unidos
19.
J Subst Abuse Treat ; 12(2): 103-9, 1995.
Artículo en Inglés | MEDLINE | ID: mdl-7623387

RESUMEN

This research investigated whether high-risk injection drug users (IDUs) manifest distinct types, or profiles, of interpersonal cognitive problem-solving (ICPS) abilities. Four measures of ICPS, the Means-Ends Problem-Solving procedure (MEPS), Optional Thinking Test (OTT), Awareness of Consequences Test (ACT), and Causal Thinking Test (CTT), were administered to 140 IDUs who volunteered for NIDA Demonstration Projects in Newark and Jersey City, NJ, to study high-risk behaviors in drug users and their sexual partners. At time of initial contact, none of the subjects was currently enrolled in a treatment program. Hierarchical and nonhierachical cluster analyses were used with the MEPS, OTT, ACT, and CTT scores, and five IDU problem-solving types were identified. These types represented below-average, causal, generational, consequential, and above-average problem-solving skills. A rational conceptualization of potential treatment implications for each of these types of IDU problem solvers is discussed.


Asunto(s)
Concienciación , Solución de Problemas , Abuso de Sustancias por Vía Intravenosa/rehabilitación , Pensamiento , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Síndrome de Inmunodeficiencia Adquirida/psicología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Admisión del Paciente , Centros de Tratamiento de Abuso de Sustancias , Abuso de Sustancias por Vía Intravenosa/psicología , Resultado del Tratamiento
20.
Behav Modif ; 22(1): 29-44, 1998 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-9567735

RESUMEN

This study examined whether active prompting would increase the number of free condoms taken from dispensers placed in counselors' offices in a cocaine abuse treatment clinic. Using a combined multiple baseline and reversal design, two teams of counselors were instructed to actively prompt and encourage condom taking during some conditions and to avoid commenting on or encouraging condom use in other conditions. To monitor accuracy of implementing the intervention, counselors completed a checklist for every subject they saw in their office during the day. Overall, the number of condoms taken per visit during prompting conditions was almost six times greater than during baseline conditions. However, implementation declined during the study, and all counselors complained about the intervention. Implications for dispensing free condoms to reduce HIV risk in drug abuse treatment clinics are discussed.


PIP: HIV infection is increasing among noninjecting as well as iv drug users. Of particular concern, are users of cocaine and crack cocaine, who are likely to trade sex for money or drugs and to have multiple sexual partners. This study investigated whether an active counselor intervention could increase the number of free condoms taken from dispensers placed in counselors' offices in a cocaine abuse treatment program in Philadelphia, Pennsylvania (US). A multiple baseline design across 2 teams of counselors with reversals was utilized. During the initial 5-week baseline period, when condoms were displayed on the counselors' desks but no prompts were given, an average of 0.34 and 0.25 condoms were taken per visit per team. During weeks 6-13, when counseling Team 1 utilized prompting and encouraged condom taking, this average increased to 3.17/visit. When Team 2 implemented the intervention (weeks 13-20), an average of 2.78 condoms/visit were taken. When both teams stopped the intervention, the number of condoms taken fell close to baseline levels. Resumption of the intervention increased use, but not to the previous high level. Over the entire 28-week study period, clients took an average of 0.43 condoms/visit during baseline conditions, and 2.45/visit during counselor prompting conditions. The 6-fold increase in condom uptake associated with active encouragement suggests the feasibility of this strategy for cocaine treatment programs. However, the participating counselors voiced irritation with the mandatory, sometimes intrusive intervention. The availability of free condoms in the clinic waiting area or day room represents an alternative strategy documented to increase the taking of condoms.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/prevención & control , Trastornos Relacionados con Cocaína/rehabilitación , Terapia Cognitivo-Conductual , Condones , Cocaína Crack , Conocimientos, Actitudes y Práctica en Salud , Refuerzo Verbal , Síndrome de Inmunodeficiencia Adquirida/psicología , Síndrome de Inmunodeficiencia Adquirida/transmisión , Adulto , Trastornos Relacionados con Cocaína/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Resultado del Tratamiento
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