Treatment History: Relationship to Treatment Outcomes

It is important to understand whether the number of prior treatment episodes relate to treatment completion, discharge status, and 6-month outcomes. The data set contains information on 2,429 clients in treatment. A modified Addiction Severity Index was administered at the time of admission and at 6-months postdischarge. Additionally, length of stay and discharge status data were obtained. ANOVAs, MANOVAs, and χ² tests were used. Clients with the most prior treatment episodes had greater baseline substance use and psychosocial severity, and were more likely to be treated in residential settings. Nonetheless, treatment acceptance was greatest for these clients. Clients with no prior treatment reported the least acceptance. Treatment completion rates did not vary as a function of treatment experience. Clients achieved positive changes in multiple life domains regardless of treatment history. Nevertheless, at admission, discharge and follow-up, clients with ≥ 2 treatments generally had greater problems than clients with fewer treatments.     

Motivation and Readiness for Drug Treatment: Differences by Modality and Special Populations

The purpose of this research is to expand our knowledge of motivational factors among admissions to various substance abuse treatment modalities and among those entering special programs. Differences in motivation are reported in a convenience sample of more than 6,000 admissions to 38 programs. Results from multilevel analyses show (a) an ordered increase in motivation by settings from referral to outpatient, to methadone maintenance, and to the highest levels in residential programs and (b) significantly lower motivation among admissions to programs for special populations. Results are discussed in relation to the demand characteristics of treatment and non-recovery reasons for entering treatment.     

Effectiveness of an Outreach Treatment Program for Inner City Crack Abusers: Compliance,Outcome, and Client Satisfaction

In a randomized controlled trial the effectiveness of an outreach treatment program (OTP) was compared with standard addiction care services for hard-drug addicts in Rotterdam (The Netherlands). The study aimed at chronic, high-risk crack abusers who were insufficiently engaged in standard addiction treatment services. Data were collected from February 2000 to December 2001. A total of 124 subjects participated in the study at baseline. Follow-up data were available for 94 subjects. Outcome measures included treatment compliance, outcome, and satisfaction. Data were collected by means of monthly registrations, EuropAsi interviews and an evaluation form. There was a high compliance with OTP in the treatment group; the average length-of-stay was 6 months, with visits three times a week. Although both groups were well represented in standard care, participation was mainly based on methadone maintenance. Subjects treated in OTP showed significant improvements in physical health, general living conditions, and psychiatric status, but no change in employment, substance abuse, and legal status. The control group remained almost unchanged. Clients of OTP reported feeling very satisfied with their treatment. On-the-spot incentives and a positive relationship with the care provider were directly associated with treatment retention. An outreach treatment program, as conducted in this study, is associated with high compliance, general improvement, and treatment satisfaction. Characteristics of this treatment modality are (1) assertive outreach, (2) a mixed program with incentives, and (3) a strong focus on individual-bound therapy. Further research is needed with larger groups and similar conditions at baseline assessment.     

Reliability of Form 90D: An Instrument for Quantifying Drug Use

Clients just entering treatment for nonalcohol primary drug use were asked to report on their frequency of drug use at two times 2 days apart. Test–retest correlations for the lifetime use of drugs were fair to excellent, and those for drug use in the last 90 days, although variable, were generally very good. For lifetime use, correlations were highest for opiates and stimulants and lowest for inhalants, whereas for the recent period correlations were highest for opiates and lowest for stimulants. Correlations were uniformly high for measures of general life functioning. Initial validity assessments with urine drug screen results as criterion were good, with no false negative errors in four of six drug use categories. Overall Form 90D appears to be a reasonably reliable and valid interview instrument for measuring drug use occurrence and frequency for both lifetime and recent use. Care is warranted in assessing classes of drugs that are used less frequently.     

Residential Drug Abuse Treatment for Probationers: Use of Node-Link Mapping to Enhance Participation and Progress

Node-link mapping, a graphic representation tool, was used to enhance substance-abuse treatment in a 4-month residential criminal justice program. Twelve communities of 30 to 35 probationers (“residents”) were randomly assigned to either mapping-enhanced or standard counseling. During group sessions, counselors and residents in the mapping communities collaborated to develop node-link maps representing critical issues. Counselors in standard communities used their own methods. Treatment motivation (i.e., desire for help) was assessed at intake and was used to categorize residents into three levels. Treatment involvement was measured at the middle and at the end of the program. Residents, as well as their counselors, rated those in mapping communities as participating more in group sessions than those in standard communities. Mapping residents also reported better personal progress toward treatment goals, more positive affective responses to treatment, and greater treatment engagement. Residents with higher motivation at intake had higher treatment involvement scores regardless of type of counseling received.     

Eighteen-Month Follow-Up Data on a Treatment Program for Homeless Substance Abusing Mothers

In response to the dearth of data on substance abuse treatment among homeless mothers, this study breaks new ground in presenting 18-month follow-up data on 149 homeless mothers with young children enlisted in a substance abuse treatment program. The effects of residential compared to nonresidential services were evaluated over the follow-up period. Although dropout rates were high, predictors of dropout were identified, and the residential had a lower dropout rate compared to the nonresidential comparison group. Members of both residential and nonresidential groups evidenced improvement in alcohol and drug problems and in housing stability, regardless of the amount of time they spent in the program. This project demonstrated that homeless mothers can be more successfully engaged in substance abuse programs with provisions of residential placement in addition to participation in a therapeutic community. Future interventions can take advantage of this knowledge in designing more effective programs.     

Neuropsychological Measurement of Drug Effects: Polydrug Research

Abstract

This study examined the impact of treatment intensity on cocaine use. Seventy-seven cocaine-using methadone patients were enrolled in a six-month, structured, manual-driven, cognitive behavioral treatment program. Sessions consisted of five individual and/or group sessions per week. At intake subjects showed extensive polydrug abuse, psychiatric comorbidity, criminal histories, and HIV risk behaviors. Treatment intensity was measured by dividing number of sessions attended into quartiles. Paired comparisons, within treatment quartiles, were made between subjects' intake and six-month self-reports of cocaine use. Subjects in quartiles two through four showed significant reductions in frequency of cocaine use at follow-up, with subjects who received the most treatment showing the greatest reductions in cocaine use. Bivariate and multivariate analyses showed that treatment sessions attended remained a strong predictor of reduction in cocaine use at follow-up, even after controlling for drug use at intake and background variables. The results indicate that there is a substantial treatment dose-response relationship.     

The State of Support for Research on the Epidemiology,Prevention, and Treatment of Drug Use and Drug Use Disorders in the USA

This article describes the challenge of sustaining a balanced agenda for drug use research in the USA to advance understanding of the nature and extent of drug use and drug use disorders in a population; the processes and mechanisms that underlie onset, continuing, and stopping drug dependence; how to effectively prevent the onset of and early drug use as well as the social and health consequences of such use; and how to treat and maintain those with drug use disorders. This review concludes with recommendations to achieve sustained stability of funding for and to promote the progress of epidemiologic, prevention, and treatment policy research.     

Adolescent Substance Use Following Participation in a Universal Drug Prevention Program: Examining Relationships With Program Recall and Baseline Use Status

ABSTRACT. Background: The study examined whether adolescents receiving a universal, school based, drug prevention program in Grade 7 varied, by student profile, in substance use behaviors post program implementation. Profiles were a function of recall of program receipt and substance use at baseline. Methods: A secondary analysis was conducted on data from the Adolescent Substance Abuse Prevention Study, a large, geographically diverse, longitudinal school-based cluster-randomized controlled trial of the Take Charge of Your Life drug prevention program. Profiles were created using self-reported substance use (preintervention) and program recall (postintervention) at Grade 7. First, characteristics of each of the 4 profiles of treatment students who varied by program recall and baseline substance use were explored. Then, multilevel logistic regression analyses were used to examine differences in the odds of substance use (alcohol, tobacco, and marijuana) among student profiles at the 6 additional study waves (Time 2 [Grade 7] through Time 7 [Grade 11]). Results: Pearson's chi-square tests showed sample characteristics varied by student profile. Multilevel logistic regression results were consistent across all examined substance use behaviors at all time points. Namely, as compared with students who had no baseline substance use and had program recall (No Use, Recall), each of the remaining 3 profiles (No Use, No Recall; Use, Recall; Use, No Recall) were more likely to engage in substance use. Post hoc analyses showed that for the 2 subprofiles of baseline substance users, there were only 2 observed, and inconsistent, differences in the odds of subsequent substance use by recall status. Conclusions: Findings suggest that for students who were not baseline substance users, program recall significantly decreased the likelihood of subsequent substance use. For students who were baseline substance users, program recall did not generally influence subsequent substance use. Implications for school-based drug prevention programs are discussed.     

Characteristics of Aboriginal Injecting Drug Users in Sydney,Australia: Prison History,Hepatitis C Status and Drug Treatment Experiences

Abstract

Australian Aboriginals are overrepresented in prisons and tend to be overrepresented in studies of injecting drug users (IDU). The aim of this study was to examine differences between Aboriginal and non-Aboriginal IDUs in terms of gender, prison history and hepatitis C status and testing. Secondary analyses were conducted on data from three cross-sectional studies of IDUs. These studies employed similar methodologies, with recruitment being through needle and syringe programs, methadone clinics, snowballing and street intercepts. All studies were coordinated through the National Drug and Alcohol Research Centre. Aboriginal people were overrepresented in all studies, were more likely to have been incarcerated and to report heroin as their drug of choice than non-Aboriginal IDUs. Females tended to be overrepresented among Aboriginal IDUs, were more likely to have been incarcerated and had a longer period of time since their last hepatitis C test than non-Aboriginal female IDUs. Aboriginal people are overrepresented among IDUs in Sydney. Given their greater risk of incarceration, particularly among females, Aboriginal IDUs were at greater risk of hepatitis C exposure than non-Aboriginal IDUs. The prison setting provides an opportunity to promote drug treatment and hepatitis C testing, though more needs to be done to reduce drug use and incarceration.     

基本药物制度下的合理用药探讨

目的：探讨基本药物制度下的合理用药情况。方法：通过对基本药物制度的分析,目前不合理用药的原因的分析．提出促进合理用药的相应意见。结果与结论：建立并完善基本药物制度．促进合理用药。     

Substance Abuse and Dependence Among Low Income African Americans: Using Data from the National Survey on Drug Use & Health to Demystify Assumptions

ABSTRACT

The media has portrayed African Americans as drug users and criminals. The purpose of this study is to test the assumption that low-income African Americans use more alcohol, nicotine, marijuana, and illicit drugs than other racial groups using data from the 2005 National Survey on Drug Use and Health to compare drug abuse and dependence across low income racial groups (N = 20,172). Most respondents were white, female, and older than 26 years of age. The majority completed high school and reported annual family incomes between $10,000 and $19,000. Few participants reported receiving public assistance. Drug abuse and dependence rates varied across drug type and across race. Drug dependence and abuse were measured using the Nicotine Dependence Syndrome Scale and criteria from the Diagnostic and Statistical Manual of Mental Disorders. Hierarchical regression was conducted to examine the level of association between racial background and drug abuse and dependence after controlling for age and gender. Results reveal that the assumption of high drug and alcohol use and abuse rates among low-income African Americans should be, at best, reexamined. This study has significant implications for both policy and social work practice because it breaks down normalized and biased assumptions of low-income African American drug use.     

PASS监测与不合理用药分析

目的：通过合理用药监测系统（PASS）对我院住院医嘱的用药情况进行汇总分析,发现用药决策中存在的不合理因素。方法：采用PASS系统对我院2007年10月～2008年10月期间住院医嘱进行审查,对不同类型的不合理用药归纳总结。结果：在审核的不合理医嘱中,严重警示占10．7％,较严重警示占35．9％,出现频率最高的不合理用药类型为药物相互作用,占不合理用药总数的48．8％。结论：PASS系统是审查医嘱出现不合理用药的重要工具,其使用需要与临床用药的实际情况相结合,同时也应在使用过程中不断修正改进。临床药师应逐步开展药学监护工作,同临床医师共同审核医嘱,从而减少不合理用药和药物不良反应的发生。     

人均限定疗程和药物利用指数比较研究

目的:提出人均限定疗程的概念,并以围术期抗菌药物应用为例,探讨药物利用监测指标的合理选择。方法:收集我院2009年12月-2010年4月147例Ⅰ类切口围术期患者抗菌药物的应用情况,计算所用药品的药物利用指数(DUI)和人均限定疗程,比较2个指标对抗菌药物应用情况的评价结果。结果:我院Ⅰ类切口抗菌药物的DUI和人均限定疗程对不规范用药的阳性检出率分别为61.3%和83.9%(P=0.016);以2d为界的分组统计结果为:疗程≤2d组2项指标对不规范用药检出率比较差异无统计学意义(P>0.05),疗程>2d组2项指标对不规范用药检出率差异有统计学意义(P=0.016),人均限定疗程检出率较高。结论:人均限定疗程是一个比DUI更敏感、易得的药物利用监测指标。     

During Treatment Changes in Substance Abuse Patients with Posttraumatic Stress Disorder: The Influence of Specific Interventions and Program Environments

Male substance abuse patients with posttraumatic stress disorder (PTSD) (SA-PTSD; N = 140) were compared to patients with only substance use disorders (SA-only; N = 1,262), and those with other Axis I diagnoses (SA-PSY; N = 228) on changes during substance abuse treatment. Diagnoses were determined by chart review, and patients completed questionnaires assessing coping, cognitions, and psychological distress. Although SA-PTSD patients improved on outcomes during treatment, they showed less benefit relative to SA-only patients. At discharge, SA-PTSD patients reported less use of effective coping styles, and endorsed more positive beliefs about substance use than SA-only patients. They had more psychological distress than SA-only and SA-PSY patients. More counseling sessions devoted to substance abuse and family problems, and increased involvement in 12-step activities partially counteracted the negative effects of having a PTSD diagnosis on several outcomes. SA-PTSD patients reported fewer psychological symptoms at discharge in programs that were high in support and order/organization.     

伪膜性肠炎的药物治疗方案与评价

目的:了解伪膜性肠炎的机制和治疗方案,以期为临床合理用药提供参考。方法:查阅国内外近期相关文献对伪膜性肠炎的病原学、发病机制及防治进行分析评价。结果及结论:抗生素的大量应用导致伪膜性肠炎发病率逐渐攀升,艰难梭菌为其主要致病菌。为有效控制伪膜性肠炎的发病应合理使用抗生素,严格控制用药指征。     

Substance Abuse/Dependence Treatment: A European Perspective

ABSTRACT. During the past decade, substantial progress has been made in the field of addiction medicine in Europe, particularly regarding the development of new treatment interventions, resulting in a wide range of therapeutic options for patients with substance use disorders. However, not all interventions are evidence based. Patients with cannabis and cocaine/amphetamine use disorders and special patient populations especially lack evidence-based treatment recommendations. Many patients undergo treatment that has not been scientifically evaluated for quality and efficacy. Moreover, there are large disparities regarding availability and treatment access across Europe, with the new member states of the European Union (EU) reporting long waiting lists and low treatment coverage. Even in Austria, which ranks among the countries with relatively high treatment coverage and good diversification of treatment in opioid maintenance therapy due to the availability of methadone, buprenorphine, and slow-release oral morphine (SROM), a considerable population of untreated or inadequately treated patients exists. Treatment for substance use disorders in Europe still has scope for improvement in terms of treatment availability and access, which is ideally provided by further development and implementation of evidence-based interventions.     

The Effects of Victimization on Drug Use: A Multilevel Analysis

Agnew's general strain theory suggests that negative life experiences constitute stress that may lead to deviance, unless effective coping strategies are forthcoming. In the present study, the principles of general strain theory were employed to examine the age-varying effects of three types of victimization on drug-using behavior: sexual victimization, physical victimization, or other victimization. Study data came from seven waves of the National Youth Survey, a longitudinal survey of youth ages 11 to 17 years when the study began in 1976. The broad hypotheses of general strain theory were supported, by the data, with some qualifications. Results of the data analysis also showed that victimization's impact on drug use is type-specific and/or drug-specific. Further studies with more sophisticated measures of drug use should clarify the role of victimization (by type) in various drug-using behaviors. The study's limitations are noted.