Vouchers versus prizes: contingency management treatment of substance abusers in community settings

Contingency management (CM) interventions usually use vouchers as reinforcers, but a new technique awards chances of winning prizes. This study compares these approaches. In community treatment centers, 142 cocaine- or heroin-dependent outpatients were randomly assigned to standard treatment (ST), ST with vouchers, or ST with prizes for 12 weeks. CM patients remained in treatment longer and achieved greater durations of objectively confirmed abstinence than did ST patients; CM conditions did not differ significantly. Although abstinence at 6- and 9-month follow-ups did not differ by group, the best predictor of abstinence was longest duration of abstinence achieved during treatment. Thus, prize and voucher CM systems are equally efficacious in promoting long durations of abstinence, which in turn are associated with benefits posttreatment.     

General practitioners' selection of patients for treatment in community psychiatric services

In a Danish community psychiatric service the patients referred from general practitioners (GPs) to the community psychiatric service (CPS) are compared with matched individuals with conspicuous psychiatric morbidity treated in general practice only. The psychopathology of the referred patients is more severe, as estimated by two different methods. They make fewer social contacts and their work situations are unfavourable. It was found that to a great extent the GPs refer their patients with mental disorders to the CPS so that the 'filter' between the GP and the CPS is very permeable. Of the patients treated by the GPs only (the matched group), no more than 54% were assessed by a psychiatrist as psychiatric 'cases'. Psychopathology thus only partly determines the GPs' assessment of psychiatric 'caseness', in which social impairment plays an important part. The GPs diagnose more mental disorder than the psychiatrists, possibly because of an intimate acquaintance with the anamnesis.     

A program for the treatment of posthospitalized mental patients in a low-income black community.

An aftercare treatment program was developed and implemented to service posthospitalized mental patients from a low-income black community of more than 33,000 residents. The program was designed and structured for this specific clinical population to meet the individual's mental health needs in most areas of lifefunctioning. Given the lack of adequate follow-up treatment which often characterized poverty areas, the program adopted a multidisciplinary approach to treatment incorporating psychiatrists, psychologists, social workers, art therapists, and activity therapists. It was concluded that the multifacet, multidisciplinary program as implemented demonstrates a viable approach for providing services to previously neglected low-income residents in this inner-city predominantly black community.     

AIDS in the black community: public health implications

As of the end of September 1988, 16,600 cases of acquired immunodeficiency syndrome (AIDS) have been reported in New York City, including 5,248 cases among blacks, 32 percent of the total. Of these, 4,220 (80 percent of adults) are men, 1,028 (19 percent of adults) are women, and 195 are children.     

Ethanol-induced alterations of matrix network in the duodenal mucosa of chronic alcohol abusers

 Excessive consumption of alcoholic beverages may be associated with gastrointestinal symptoms, including dyspepsia and diarrhoea. It is not clear whether or not chronic alcohol ingestion damages the mucosa of the small intestine. We investigated the effect of chronic alcohol abuse on the duodenal mucosa, and particularly on its extracellular matrix (ECM) network. Duoenal biopsy specimens were obtained during upper gastrointestinal endoscopy from 50 chronic alcoholics without cirrhosis and 10 healthy subjects. Morphological studies were performed by routine histology, immunohistochemistry and electron microscopy. Morphometry of duodenal tissues was performed with a computerized image analyser. No significant duodenal epithelial changes were found in alcoholics, despite an evident reduction in the enterocyte turnover. Myofibroblast-like cells were significantly increased in the villus stroma of alcoholics in comparison to controls. These cells stained positively for desmin, α-smooth muscle actin and for several ECM components. In alcohol abusers the thickness of the mucosal basement membrane was greater and the staining for collagen I and III was enhanced both in the basement membrane and in the villus stroma. A higher expression of tenascin was also seen at the base of villi of alcoholics. Chronic alcohol abuse may induce fibrosis of duodenal villi which is associated with a transformation of villus juxta-parenchymal cells into active subepithelial myofibroblast-like cells able to produce different ECM components. Received: 3 June 1998 / Accepted: 26 October 1998