Gender differences among HIV-positive methadone maintenance patients enrolled in a medication adherence trial.

This study examined baseline gender differences among HIV-positive methadone maintenance outpatients currently prescribed antiretroviral medications. Participants were enrolled in a larger clinical trial, which included a 4-week observation period using electronic monitors to track medication adherence. Contrary to previous literature, no significant differences were detected between men (n = 42) and women (n = 36) on medication adherence or depression. Both groups showed remarkably poor adherence during baseline (M = 56% of doses taken on time), high overall prevalence of depression (47%) and illicit cocaine use (47%). Women reported significantly more medication side effects (M = 21.4 vs. 14.9), higher severity of ASI psychiatric problems (M = 0.50 vs. 0.40), and lower SF-36 health-related quality of life in physical (M = 42.1 vs. 63.3) and emotional functioning (M = 26.9 vs. 58.9) than men. Women tested positive for opioids at higher rates than men (53% vs. 29%, respectively), whereas men were more likely to be positive for benzodiazepines than women (26% vs. 6%, respectively). Findings suggest that gender differences between male and female methadone maintenance patients have relevance to treatment providers. Extensive assessment, specialized medical care and mental health services may be warranted in the treatment of HIV-positive female drug abusers.

Clinical course and short-term outcome of hospitalized adolescents with eating disorders: the success of combining adolescents and adults on an eating disorders unit.

Although significant controversy exists regarding the appropriate setting for treating adolescents with eating disorders, empirical studies have been lacking. This study aimed to evaluate, and compare with adults, the clinical course and short-term outcome of adolescents with eating disorders hospitalized on an adult eating disorders unit. One hundred forty-four consecutive inpatient admissions on a weight gain protocol (28% minors and 72% adults) completed psychometric measures and were assessed on clinical indices. No differences between minors and adults were demonstrated for weight gain per week on either inpatient or partial hospitalization admissions. Whereas inpatient length of stay was equivalent, adolescents stayed significantly longer in partial hospitalization than adults. Minors did not differ from adults on the presence of problematic eating disordered behaviors or most psychometric measures, although they had less functional interference due to their eating disorders. Results suggest that an adult eating disorders specialty program can be an appropriate and efficacious setting for adolescents.

Smoking during pregnancy and intention to quit: a profile of methadone-maintained women.

The present study characterized cigarette smoking patterns (self-report, carbon monoxide, and cotinine), health-risk perceptions, attitudes, and quitting intentions among pregnant methadone-maintained women (n = 50) enrolled in comprehensive perinatal drug treatment. At baseline, women expressed only moderate motivation and self-efficacy for smoking cessation, and 60% were in the precontemplation stage of change for quitting. Follow-up assessment during pregnancy (n = 40) showed no change in self-reported cigarettes per day or cotinine values. Despite recognition of the personal and fetal health risks of smoking and high social support for quitting, none of the women stopped smoking and few demonstrated reduction. Compared to other pregnant smokers, this sample is characterized by many of the factors associated with difficulty in quitting. Innovative harm-reduction strategies and nicotine replacement medications deserve scientific attention in this high-risk group of tenacious smokers.

Cigarette smoking and its relationship to other substance use among eating disordered inpatients.

OBJECTIVE: The present study examines prevalence rates of tobacco, caffeine, alcohol and other substance use and abuse among eating disordered inpatients and compares smokers (regular vs occasional vs non-smokers) and eating disorder (ED) subtypes [anorexia nervosa (AN) vs bulimia nervosa (BN); restrictors vs purgers] on substance use behaviors, family history, depressive symptoms and impulsivity. METHOD: Participants were 100 ED inpatients who completed assessment upon treatment entry. RESULTS: A high incidence of regular cigarette smoking (29%) and occasional smoking (13%) was detected and associations were found with caffeine abuse, alcohol and marijuana use, family history and depression. BNs were more likely to smoke occasionally and use alcohol than ANs, while Purgers demonstrated higher caffeine and alcohol use than Restrictors. DISCUSSION: Comprehensive assessment and intervention for smoking, caffeine and other substance use among ED patients is clearly indicated.

MMPI-2 typology of pregnant drug-dependent women in treatment.

The present study examined the validity of Minnesota Multiphasic Personality Inventory-2 (MMPI-2) typology for pregnant drug-dependent women. A 3-cluster solution based on 7 MMPI-2 clinical scales emerged as the best model and was replicated across split-half samples and different primary substance-use diagnoses and treatment modalities. The 3 subtypes identified included Type I (n = 40, 24%) with no clinical elevation, Type II (n = 72, 42%) with elevated psychopathic deviate scale, and Type III (n = 58, 34%) with elevations on all 7 scales. Analyses with interview and self-report measures showed good concurrent validity. Type II had higher retention than Type I and Type III across methadone and medication-free treatments, showing some predictive validity. An a priori method for classifying new cases on the basis of the proposed typology was developed and validated. Study findings support MMPI-2's use with pregnant drug-dependent women for assessment and possibly treatment planning.

Psychopathology in pregnant drug-dependent women with and without comorbid alcohol dependence.

BACKGROUND: Individuals with comorbid alcohol and drug use disorders are at particularly high risk for a variety of problems, including other psychiatric disorders. In general, patients with comorbid alcohol and drug dependence tend to have more severe dependence problems and often have poorer treatment outcomes than individuals with single disorders. For treatment-seeking pregnant women, psychiatric comorbidity can lead to relapse and premature treatment dropout, with adverse consequences to mother and infant. METHODS: Psychopathology, as measured by the Minnesota Multiphasic Personality Inventory-Revised (MMPI-2), was examined in 170 pregnant women admitted to a comprehensive treatment program for cocaine or opiate dependence. Most were single (75%) and African American (80%), with a mean age of 29 years. Thirty-six met DSM-III-R criteria for both alcohol and drug dependence (alcohol positive), whereas 134 were drug dependent only (alcohol negative). RESULTS: Alcohol-positive women had higher levels of psychopathology than alcohol-negative women, with higher scores on scales 2 (Depression), 4 (Psychopathic Deviance), 8 (Schizophrenia), and 0 (Social Introversion; p < 0.05). The mean MMPI-2 profile for alcohol-positive women was 2-4-8 (Depression-Psychopathic Deviance-Schizophrenia; all T-scores > 65), whereas alcohol-negative women had only a scale 4 increase. CONCLUSIONS: Results suggest that pregnant, drug-dependent women with comorbid alcohol dependence present for treatment with greater psychopathology and thus may require more intense interventions than pregnant, drug-dependent women without comorbid alcohol dependence. Alcohol use by pregnant women is particularly important to address in treatment, because alcohol is a known teratogen associated with mental retardation and behavioral problems.

Characterizing pregnant drug-dependent women in treatment and their children.

Alcohol and other drug use during pregnancy represents a major public health concern. This article characterizes a sample of 240 pregnant opioid- or cocaine-dependent women enrolled in the initial residential component of a comprehensive substance abuse treatment program for pregnant women. Data were collected using the Addiction Severity Index, Psychosocial History Form, and Structured Clinical Interview for DSM-III-R. Patients' substance use history, psychiatric comorbidity, social support network, employability, current and previous pregnancies, child custody arrangements, and the father of the current pregnancy, are described to assist providers in tailoring treatment to the specific needs of this population.

Clinical and psychosocial characteristics of substance-dependent pregnant women with and without PTSD.

The present study compared psychiatric and psychosocial functioning in 123 pregnant opiate- and/or cocaine-dependent women with and without a comorbid diagnosis of posttraumatic stress disorder (PTSD). Participants were enrolled in a comprehensive perinatal drug treatment program and completed assessments upon admission. Lifetime diagnostic prevalence of PTSD [Structured Clinical Interview for DSM-IV Disorders (SCID) confirmed] among the sample was 19%. Participants with PTSD (n=24) reported greater need for psychiatric treatment, were more likely to report a previous suicide attempt, and had more previous drug treatments than participants without PTSD (n=99). Women with PTSD were twice as likely to have lifetime Axis I and Axis II disorders and had higher rates of abuse than women without PTSD. Lifetime sexual abuse and ASI family/social composite scores were significant predictors of PTSD. Findings suggest that pregnant drug-dependent women with comorbid PTSD may benefit from specialized treatment services for trauma and/or abuse issues.

Buprenorphine treatment of pregnant opioid--dependent women: maternal and neonatal outcomes.

This open-label prospective study examined maternal and neonatal safety and efficacy outcome measures during and following prenatal buprenorphine exposure. Three opioid-dependent pregnant women received 8 or 12 mg sublingual buprenorphine tablets daily for 15-16 weeks prior to delivery. Results showed that buprenorphine in combination with comprehensive prenatal care was safe and effective in these women. Prenatal exposure to buprenorphine resulted in normal birth outcomes, a mean of 4.33 days (minimum possible=4) hospitalization, and a 'relatively mild' neonatal abstinence syndrome comprised primarily of tremors (disturbed), hyperactive moro and shortened sleep after feeding. The infants required no pharmacological treatment. Onset of neonatal abstinence signs occurred within the first 12 h after birth, peaked by 72 h and returned to below pre-12 h levels by 120 h. It is concluded that buprenorphine has potential utility for the treatment of pregnant opioid-dependent women.

Improving treatment outcomes for pregnant drug-dependent women using low-magnitude voucher incentives.

The aim of this study was to examine the effectiveness of low-magnitude behavioral incentives in improving attendance for abstinence-treated patients and sustaining illicit-drug abstinence for methadone-treated patients. Subjects were randomly assigned to either incentive or control conditions, with target behaviors differing for the two patient groups (attendance for abstinence-treated and abstinence for methadone-treated patients). Controls received no incentives, whereas incentive subjects could earn $5/day in vouchers during the first 7 days of an intensive outpatient treatment. Results showed that $5/day did not significantly improve attendance in abstinence-treated patients or impact drug abstinence in methadone-treated patients. The data suggest that low-magnitude voucher incentives enhanced treatment attendance by methadone-treated subjects. Although modest monetary incentives had some utility in improving attendance in methadone-treated patients, more potent interventions are needed to improve attendance and maintain abstinence in this high-risk population.

Attendance incentives for outpatient treatment: effects in methadone- and nonmethadone-maintained pregnant drug dependent women.

The effectiveness of behavioral incentives for improving treatment participation and retention in samples of methadone-maintained (n = 66) and nonmethadone-maintained (n = 76) pregnant drug dependent women was examined. Subjects were randomly assigned to receive $0 (standard care) and $1, $5, or $10/day for attending at least 4 h of interdisciplinary treatment programming during the first 7 consecutive days after transfer from residential to outpatient care, with payment dispensed in the form of gift certificates. Methadone-maintained women attended nearly twice as many full treatment days as those not receiving methadone (5.2 vs 2.8 days; P < 0.001) and were retained in treatment significantly longer (86.4 vs 28.9% active in treatment at 30 days). There was no main effect of incentives and no effect on attendance in methadone patients. However, nonmethadone patients offered higher magnitude incentives ($5/$10) attended 3.3 days out of 7 on average, compared to 2.3 days for those offered $0 or $1 per day (t = 1.73; P < 0.05). The study confirmed that methadone maintenance is a powerful therapeutic adjunct which is associated with significantly better treatment retention and participation in ancillary programming than is abstinence-based treatment. It was also found that modest financial incentives can facilitate treatment participation for abstinence-based patients. However, more potent interventions would be needed to match the effectiveness of methadone in this regard.

Detecting alcohol problems in drug-dependent women of childbearing age.

Alcohol problems frequently go undetected in drug-dependent individuals. In women of childbearing age, the consequences of unrecognized alcohol problems can be severe. Unfortunately, many drug treatment programs lack resources to conduct formal diagnostic interviews with all program admissions. Using the Structured Clinical Interview for DSM-III-R (SCID) as the "gold standard," the present study compared four clinical tools for assessing alcohol problems in a drug-dependent population. Rates of detecting alcohol problems varied widely (15-76%). The Addiction Severity Index (ASI) and the Family Alcohol and Drug Survey (FADS) yielded the highest sensitivities (96% and 83%, respectively) and specificities (94% and 92%, respectively). Since these instruments require less staff training and background education than the SCID, they offer cost-effective alternatives for efficient screening and assessment of alcohol problems in drug-dependent populations.