Risky decision-making predicts short-term outcome of community but not residential treatment for opiate addiction. Implications for case management.

BACKGROUND: Opiate addiction is associated with decision-making deficits and we previously showed that the extent of these impairments predicts aspects of treatment outcome. Here we aimed to establish whether measures of decision-making performance might be used to inform placement matching. METHODS: Two groups of opiate dependent individuals, one receiving treatment in a community setting (n=48) and one in a residential setting (n=32) were administered computerised tests of decision-making, impulsivity and planning shortly after the beginning of treatment, to be followed up three months into each programme. RESULTS: In the community sample, performance on the decision-making tasks at initial assessment predicted abstinence from illicit drugs at follow-up. In contrast, in the residential sample there was no relationship between decision-making and clinical outcome. CONCLUSIONS: Intact decision-making processes appear to be necessary for upholding a resolve to avoid taking drugs in a community setting, but the importance of these mechanisms may be attenuated in a residential treatment setting. The results support the placement matching hypothesis, suggesting that individuals with more prominent decision-making deficits may particularly benefit from treatment in a residential setting and from the inclusion of aspects of cognitive rehabilitation in their treatment programme.

A multicentre, randomized, double-blind, placebo-controlled trial of naltrexone in the treatment of alcohol dependence or abuse.

The opioid antagonist, naltrexone, is reported, in single centre studies, to improve the clinical outcome of individuals with alcohol dependence participating in outpatient psychosocial programmes. This is the first multicentre controlled study to evaluate the efficacy and safety of naltrexone as adjunctive treatment for alcohol dependence or abuse. Patients who met criteria for alcohol dependence (n = 169) or alcohol abuse (n = 6) were randomly assigned to receive double-blind oral naltrexone 50 mg daily (n = 90) or placebo (n = 85) for 12 weeks as an adjunct to psychosocial treatment. The primary efficacy variable was time to first episode of heavy drinking; secondary efficacy assessments included time to first drink, alcohol consumption, craving, and changes in the serum biological markers gamma-glutamyl transferase (GGT), and aspartate and alanine aminotransferases. Compliance was assessed by tablet counts and, in the naltrexone-treated group, by measurement of urinary concentrations of 6-ss-naltrexol. Forty-nine (58%) patients randomized to placebo and 53 (59%) randomized to naltrexone did not complete the study. In intention-to-treat analyses, there was no difference between groups on measures of drinking. The median reduction from baseline of serum GGT (P: < 0.05) and the reductions in alcohol craving (Obsessive and Compulsive Drinking Scale: OCDS) were greater in the naltrexone group (P: < 0.05), from approximately half-way through the study. Of 70 patients (35 placebo; 35 naltrexone) who met an a priori definition of compliance (80% tablet consumption, attendance at all follow-up appointments), those allocated to naltrexone reported consuming half the amount of alcohol (P: < 0.05), had greater median reduction in serum GGT activity (P: < 0.05), and greater reduction in alcohol craving (OCDS total score: P: < 0.05; Obsessive subscale score: P: < 0.05), compared to patients in the placebo group. Use of naltrexone raised no safety concerns. Naltrexone is effective in treating alcohol dependence/abuse in conjunction with psychosocial therapy, in patients who comply with treatment.

Sexual abuse in people with alcohol problems. A study of the prevalence of sexual abuse and its relationship to drinking behaviour.

BACKGROUND: There is evidence that people with a history of sexual abuse may have an increased risk of developing alcohol and drug problems. METHOD: A self-completion sexual abuse questionnaire was designed and administered to a sample of attenders at three London alcohol services. Drinking behaviour was assessed using the Severity of Alcohol Dependence Questionnaire and the Alcohol Problems Questionnaire, and additional data were derived from case notes. RESULTS: Fifty-four per cent of women and 24% of men identified themselves as victims of sexual abuse or assault For the majority this had started before the age of 16 and involved non-relatives. Subjects with a history of sexual abuse were younger, reached drinking milestones earlier, were more likely to have a family history of alcohol misuse and had more alcohol-related problems than non-abused subjects. Sexual abuse, age and alcohol dependence predicted level of problems in a regression analysis. CONCLUSIONS: The high rates of sexual abuse and its association with indications of increased morbidity suggest it is an important issue for the management of alcohol problems. More use could be made of self-completion questionnaires for the investigation of sexual abuse.

PIP: Several community-based studies have found significantly higher rates of alcohol and drug abuse among those with a history of child sexual abuse. This association was investigated further in a sample of 126 consecutive attendees (89 men and 37 women) at three alcohol treatment centers in London, England. 25 men (24%) and 21 women (54%) reported a sexual abuse history. 43 (69%) of the 62 perpetrators reported by respondents were not family members. The mean age at first occurrence of abuse was 12.6 years and 75% of victims were 15 years of age or younger at first incident. Victims of sexual abuse were younger at presentation for treatment and had significantly higher scores on the Severity of Dependence Questionnaire and the Alcohol Problem Questionnaire than their nonabused counterparts. They also developed drinking problems at an earlier age and were more likely to have other psychiatric problems. 53.4% of the variance in drinking was contributed by alcohol dependence, age, and sexual abuse. These findings suggest that sexual abuse is a common childhood experience among men and women who seek help for alcohol problems. However, the lack of a control group of non-drinkers limits assessment of a possible causal link between child sexual abuse and subsequent alcohol misuse.

High-pressure EPR cavity.

A high-pressure resonant cavity for sensitive EPR measurements is described. The cavity operating in the TE(115) cylindrical mode enables EPR experiments to be carried out in the 77-300 K temperature range at high hydrostatic pressure up to 8 kilobar.