Relation of client variables to continuance in five types of alcohol treatment settings.

Multiple regression analyses were used to assess the relationship of 29 client variables to continuance in five types of alcohol treatment settings (outpatient, inpatient, social detoxification, halfway houses with highly structured treatment regimens, and halfway houses with minimal structured treatment; N = 3,240). Socioeconomic variables were most often related to continuance; however, the pattern of the relationship between predictor variables and continuance varied greatly from setting to setting. The strongest multiple regression coefficients were found for outpatient and inpatient settings and the weakest were found for the two types of halfway house settings. It was concluded that archive-derived variables had significant, but limited, power to predict continuance and that other approaches to investigating continuance are needed.     

Alcoholic patients' decisions about halfway houses What they say,what they do

Because of the important role of halfway houses in the recovery of many alcoholic patients, patients' attitudes toward accepting placement in a halfway house were studied in a state hospital's alcohol rehabilitation program. Verbal intentions to accept or not to accept placement were measured at the beginning and again toward the end of the program sequence. Both assessments showed a strong correlation with the patients' actual behaviors. The relationships between intentions and ultimate choices were moderated both by the amount of time between observations and, independently of the passage of time, by the subjects' experience with or knowledge about halfway houses. Changes over the course of the program were mostly positive (favorable toward going and actually doing so). These shifts mainly involved the people who had been initially undecided about placement in a halfway house. Amount of time spent in the rehabilitation program was unrelated to patients' initial intentions toward going and had little bearing on their final decisions.     

Halfway houses for skid row alcoholics: Are they rehabilitative?

A critical review of research reports on halfway house programs for alcoholics indicated that most of these reports have serious shortcomings regarding their clarity and in the quality and quantity of reported data. Such data as were presented do not lend support to the notion that halfway houses make a substantial contribution to the rehabilitation of skid row alcoholics.     

Overdose history is associated with postdetoxification treatment preference for persons with opioid use disorder

Background: Without aftercare treatment, persons discharged from short-term inpatient detoxification for opioid use disorder are at high risk of relapse. In previous work, those who were recently homeless or had pending legal problems were more likely to prefer residential treatment for aftercare. Here, based on clinical experience, the authors hypothesize that a particular clinical factor, surviving an opioid overdose, will be associated with aftercare preference. Methods: Between May and December 2015, the authors surveyed consecutive persons seeking inpatient opioid detoxification. To assess aftercare treatment preference, participants were asked, “If you had unlimited treatment options and all were free, which one would work best for you when you leave here?” To assess overdose history, participants were asked about overdose “since your first drug use,” and “in the last year.” Results: Participants' (N = 440) mean age was 32.3 (± 8.7) years; 70.7% were male. More than half (51.1%) of participants expressed an aftercare preference for medication-assisted treatment (MAT), 12.7% for outpatient counseling only, 10.7% for residential treatment,18.6% for no formal treatment (Narcotics Anonymous/Alcoholics Anonymous only or a halfway house), and 6.8% did not want any postdetoxification treatment. About 40% reported a history of overdose, and 24.8% reported past year overdose. In the multivariate model, treatment preference was associated with sex (P < .001), homelessness (P = .01), and history of drug overdose (P = .02). Conclusions: Although MAT was preferred by the majority of participants, the experience of a nonfatal overdose was associated with the choice of residential treatment as postdetoxification treatment.     

Predicting Alcoholism Service Needs from a National Treatment Utilization Survey

Even when the prevalence of alcohol abuse and alcoholism allows for resource allocation based on differential problem size, further planning methods are necessary in order to determine what specific types of services should be developed to meet the estimated need. Using population-based variables (e.g., total population, White and minority populations) and easily obtainable alcohol indicator variables (consumption, revenue, alcohol-related deaths and arrests), regression models were developed to predict state bed capacity data, obtained from the 1980 National Drug and Alcoholism Treatment Utilization Survey (NDATUS). Prediction models are presented for detoxification, quarterway and halfway house, other residential, hospital, and outpatient. Several variables, particularly total population, deaths, and arrests, are predictive of alcoholism service levels by state, as reflected on NDATUS. Based on this study, estimates of specific service needs within a geographic area can be made by varying the values of the independent variables in the models to reflect the characteristics of the area.     

Brief report: Abstinence and abusive drinking among affiliates of alcoholics anonymous: Are these the only alternatives?

Reanalysis of data in the Rand report and data from a follow-up study of halfway house residents showed that, when subject characteristics were controlled, regular Alcoholics Anonymous attenders who also drank, reported more physical and other negative consequences than drinkers who attended AA less often. The possibility is raised that these results reflect the influence of a self-fulfilling prophesy of loss of control following drinking.     

Discharge patterns of residents from halfway houses for male alcoholics

Length of stay (LOS) data for male alcoholics discharged from eight halfway houses were examined in the light of the hypothesis that the rate of discharge would be a linear function of time. In general, the hypothesis was confirmed, although the rate of discharge for four houses was significantly accelerated during the first two weeks of residence. Further analysis showed that both resident characteristics and house structure (defined in terms of the number of hours of formal activities each week) contributed significantly to LOS. Resident characteristics accounted for 5.3% of the variance in LOS when house structure was controlled, and structure accounted for 1.6% of variance when resident characteristics were controlled. No significant interaction effects were detected. Implications of these results are discussed.     

The effectiveness of post-detoxication referrals: effects on later detoxication admissions, drunkenness and criminality.

This study concerned the effectiveness of post-detoxication referrals to a variety of treatment facilities. The purpose was to discover (i) the proportion of men accepting referrals who actually arrived, (ii) the differences in outcome for patients attending an out-patient clinic, a halfway house, and a long-stay farm, (iii) the differences in outcomes for patients treated in one of the above facilities compared with those for similar patients not receiving treatment. In all, 114 male detoxication admissions were included. However, only 60% arrived, even when firm referrals were made. Those arriving and not arriving did not differ in social or demographic characteristics, nor did those who were referred to the various treatment facilities. However, the referral group had more detoxication admissions in the post-detoxication period. There were no post-treatment overall differences between all treated and untreated patients in detoxication admissions, arrests for drunkenness or criminal convictions. Refusals were more often successes than the treated or untreated groups but this was due to their better prognosis at intake. In general, the data provide little cause for optimism about the value of post-detoxication referrals.     

HIV risk reduction and service delivery strategies in criminal justice settings

Because of the HIV risk behaviors of substance abusers, particularly injection drug users and those who exchange sex for drugs, and the large numbers who are already infected with HIV or showing symptoms of AIDS, significant service delivery issues are associated with their criminal justice processing. Many strategies have been implemented in correctional settings in an effort to prevent and control the transmission of HIV. A number of these are for the purpose of lowering transmission risk in institutions, whereas others have been structured for the sake of offering prevention/intervention to inmates before they return to the free community. As such, prisons and jails represent opportune settings for HIV prevention and education. The most common HIV control/prevention/education strategies include mandatory testing of inmates for HIV, segregating infected inmates from the general prison population, establishing special health care units for HIV positive and AIDS symptomatic inmates, offering HIV prevention and risk reduction programs, and granting medical parole for the terminally ill. Because drug abuse treatment results in substantial declines in the use of heroin, cocaine, and other drugs, treatment per se can play a significant role in reducing the spread of HIV and AIDS among those coming to the attention of the criminal justice system. Most promising are continuous and integrated treatment services that are tied to the stages of correctional supervision: primary treatment while incarcerated; secondary treatment while on work release, halfway house or community supervision; and, tertiary treatment in ongoing aftercare.     

Examining Treatment Climate Across Prison-Based Substance Abuse Treatment Groups

Background: With notable exceptions, few studies have looked critically at the role and effects of factors other than individual or programmatic differences that contribute to the climate within substance abuse treatment programs. De Leon's work on the therapeutic community, however, indicates that factors beyond the individual and program can contribute to the overall functioning of similarly situated communities. Objectives: In this study, we introduce and examine the concept of the “treatment group,” the level of aggregation between the individual who participates in treatment and the organization that provides it. The treatment group refers to the social context and dynamics that operate among treatment participants, and we sought to study differences in treatment climate across 12 prison-based treatment groups within a single prison. Methods: Using data from 604 participants who were assigned at random to one of the 12 groups, we analyzed differences on seven treatment climate indicators from one month and six months into the program across the treatment groups. Results: No differences were found among the treatment groups at after one month; however, after 6 months, significant differences emerged across the groups on three treatment climate variables: program structure, counselor rapport, and counselor competence. Conclusions/Importance: This study is among the first of its kind to conceptualize and examine treatment climate across otherwise similar groups and find that differences emerge on several indicators of climate. As such, we argue that the treatment group may be important to consider in both the delivery and evaluation of substance abuse treatment.     

Dietary choices of recovering alcoholics

Nutritional therapy can play an important role in the rehabilitation of an alcoholic. To teach these patients proper eating habits, we need to know what they eat and whether their dietary choices are nutritionally adequate compared to the recommended daily allowances (RDA). We investigated dietary choices of 70 recovering (abstinent) alcoholics who lived in a halfway house but who ate and worked elsewhere everyday. Diets were analyzed for calories, protein, B vitamins, vitamins A and C, calcium, phosphorous, magnesium, iron and zinc. We found that these recovering alcoholics ate adequate amounts of all nutrients except for vitamin B₆, magnesium, iron and zinc. With the exception of vitamin B₆, the other three nutrients are also found to be low in the diets of the average population. We cannot say at present whether recovering alcoholics need more than the RDA for recovery, but we conclude that their freely chosen diet resembles that of non-alcoholic adult Americans.     

Phylogenetic analysis of house dust mites

House dust mites live in house dusts and affect the health of humans. Among the many species, Dermatophagoides farinae, D. pteronyssinus, and Euroglyphus maynei have been found to be commonly associated with Ig-E-mediated allergic diseases. As a result, there is increasing effort to develop methods for the diagnosis and treatment of diseases caused by these species. The purpose of the current study was to explore the evolutionary relationships among house dust mites. After adult D. farinae were separated and isolated for total RNA extract, the cDNA coding for Der f 1 and Der f 2 were cloned and sequenced. Then amino acid sequences for group 1 and 2 allergens of two of the most common house dust mites, D. pteronyssinus, E. maynei, were obtained from databases. Interestingly, homological analysis of amino acid sequences showed that both Der p 1 and Der p 2 from D. pteronyssinus had more similarities to Eur m 1 and Eur m 2, respectively, than they had to Der f 1 and Der f 2 from D. farinae. In the phylogenetic trees, D. pteronyssinus clustered with E. maynei, but not with D. farinae, although D. pteronyssinus and D. farinae belong to the same genus according to morphological taxonomy. It was previously assumed that D. pteronyssinus was more similar to E. maynei than to D. farinae at evolutionary levels.     

Drinking Goals and Their Association With Treatment Retention and Treatment Outcomes Among Clients in Outpatient Alcohol Treatment

Background: Few studies have compared characteristics of clients entering alcohol treatment who differ in their drinking goal preferences or have investigated the relevance of drinking goals as a predictor of treatment outcomes. Objectives: To investigate associations between baseline drinking goal preferences and client characteristics as well as treatment retention and outcomes among clients in outpatient alcohol treatment. Methods: Secondary data analyses on a longitudinal multicenter study investigating the effectiveness of outpatient alcohol treatment in Switzerland among 805 clients. Assessments were conducted at treatment admission, discharge, and at 6- and 12-month follow ups. At-risk drinking was assessed through the alcohol use disorders identification test. Treatment retention was defined as regular discharge with or without transition into another institution. Results: Clients aiming to abstain from drinking were more likely to be in retreatment, to be assigned to treatment by a health institution, to have no at-risk alcohol use, and to be already alcohol abstinent at the time of admission relative to clients who aimed to control their drinking. Clients without at-risk alcohol use at admission showed higher treatment retention when aiming for controlled drinking than for abstinence, while there was no difference in treatment retention among clients with at-risk use. Clients with at-risk use at admission were more likely to reach not-at-risk alcohol use status when aiming for alcohol abstinence than for controlled drinking. Conclusions: Drinking goals are associated with variables of alcohol use and treatment assignment. They have different effects on treatment retention and treatment outcomes according to alcohol use at the time of admission.     

Treatment Retention Satisfaction,and Therapeutic Progress for Justice-Involved Individuals Referred to Community-Based Medication-Assisted Treatment

Background: Limited research has examined factors associated with medication-assisted treatment for justice-involved individuals. Objectives: The current study used a mixed-method design to examine the influence of client- and counselor-level factors on 90-day treatment retention, satisfaction, and progress for justice-involved individuals referred to medication-assisted treatment. Methods: The effects of co-occurring disorders (i.e., psychiatric symptoms, anxiety, depression), social functioning (i.e., social support, self-esteem), substance use severity, and treatment motivation on treatment retention, treatment satisfaction, and treatment progress while controlling for counselor-level variance were assessed through multilevel modeling. Results: Fewer co-occurring disorders and more social support were related to greater treatment satisfaction and progress. A higher level of treatment motivation was associated with greater treatment progress. Mediation of treatment satisfaction on the relationship between client-level factors and treatment progress also was tested. Depression was negatively associated with treatment satisfaction, which in turn led to lower ratings of treatment progress. Social support was positively correlated with treatment satisfaction, which in turn was positively correlated with treatment progress. The association of client substance use severity with treatment retention differed between counselors, so did the association of co-occurring disorders and treatment motivation with treatment satisfaction. Qualitative analyses that were derived from counselors’ perception of factors relating to recovery success underscored the importance of integrated interventions, social support, treatment motivation, and therapeutic alliance, and their associations with treatment outcomes. Conclusions/Importance: The current findings highlight the importance of integrated treatment services, collaborating with community corrections, and teaching clients strategies for dealing with deviant peers as to facilitating recovery.     

Substance abuse treatment and receipt of liver specialty care among persons coinfected with HIV/HCV who have alcohol problems

We examined the association of substance abuse treatment with access to liver specialty care among 231 persons coinfected with HIV and hepatitis C virus (HCV) with a history of alcohol problems who were recruited and followed up in the HIV-Longitudinal Interrelationships of Viruses and Ethanol cohort study from 2001 to 2004. Variables regarding demographics, substance use, health service use, clinical variables, and substance abuse treatment were from a standardized research questionnaire administered biannually. We defined substance abuse treatment services as any of the following in the previous 6 months: 12 weeks in a halfway house or residential facility, 12 visits to a substance abuse counselor or mental health professional, day treatment for at least 30 days, or any participation in a methadone maintenance program. Liver specialty care was defined as a visit to a liver doctor, a hepatologist, or a specialist in treating hepatitis C in the past 6 months. At study entry, most of the 231 subjects (89%, n = 205) had seen a primary care physician, 50% had been exposed to substance abuse treatment, and 50 subjects (22%) had received liver specialty care. An additional 33 subjects (14%) reported receiving liver specialty care during the follow-up period. In the multivariable model, we observed a clinically important although not statistically significant association between having been in substance abuse treatment and receiving liver specialty care (adjusted odds ratio = 1.38; 95% confidence interval = 0.9–2.11). Substance abuse treatment systems should give attention to the need of patients to receive care for prevalent treatable diseases such as HIV/HCV coinfection and facilitate its medical care to improve the quality of care for individuals with substance use disorders. The data illustrate the need for clinical care models that give explicit attention to the coordination of primary health care with addiction and hepatitis C specialty care while providing ongoing support to engage and retain these patients with complex health needs.     

Treatment strategies for alopecia

Background: Hair loss is a very common complaint and dermatologists should be able to make the correct diagnosis of different types of alopecia and choose the best therapeutic strategy according to patients' and doctors' expectations. Objective: To review treatment of the most common forms of hair loss. Methods: Literature review and expert opinion. Conclusion: There is good evidence based information for the treatment of androgenetic alopecia. There are very few randomized good quality studies and no information about long-term results for most of the available treatments for alopecia areata and cicatricial alopecias. Treatment of alopecia areata and cicatricial alopecias is, therefore, selected in the absence of precise information on the expected outcome and treatment failure is common.     

Esterase-mediated spinosad resistance in house flies Musca domestica (Diptera: Muscidae)

Although esterase-mediated spinosad resistance has been proposed for several insects, the associated molecular mechanism remains poorly understood. In this study, we investigated the mechanism of esterase-based spinosad resistance in house flies using a susceptible strain (SSS) and a spinosad-resistant, near-isogenic line (N-SRS). Combined with the synergistic effect of DEF on spinosad in the N-SRS strain, decreased ali-esterase activity in the spinosad-resistant strain has implicated the involvement of mutant esterase in spinosad resistance in house flies. Examination of the carboxylesterase gene MdαE7 in the two strains revealed that four non-synonymous mutations (Trp²⁵¹-Leu, Asp²⁷³-Glu, Ala³⁶⁵-Val, and Ile³⁹⁶-Val) may be associated with spinosad resistance in house flies. Single nucleotide polymorphism analysis further indicated a strong relationship between these four mutations and spinosad resistance. Moreover, quantitative real-time PCR revealed a female-linked MdαE7 expression pattern in the N-SRS strain, which may contribute to sex-differential spinosad resistance in house flies.

     

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.     

Testing Equality of Generalized Treatment Effects

Recently, the concept of generalized treatment effect, defined as P(X > Y) where X and Y denote continuous outcome variables for treatment arm and control arm, respectively, has been proposed as an appropriate measure of treatment effect in clinical trials with parallel design. Compared to the mean difference, the generalized treatment effect has many advantages; for example, it is a scaleless measure and it does not change under monotonic transformations. This article investigates the problem of testing equality of generalized treatment effects among several clinical trials. The proposed approach follows the same vein as the generalized variable method for testing equality of several log-normal means proposed by Li (2009). Numerical study demonstrates that the proposed test has excellent type I error control for clinical trials with small to medium sample sizes. Robustness study shows that the proposed method performs reasonably for categorical data.     

Treatment strategies for focal epilepsy

Background: Treatment strategies for focal epilepsy need to take account of the phase and severity of the seizure disorder, comorbidity, gender and age. Methods: Expert review and evaluation of major studies on the treatment of focal epilepsy. Results: Complete seizure control is most often achieved with antiepileptic drug (AED) monotherapy. In the choice of AED, possible unfavourable endocrine, cognitive or psychiatric adverse effects and their interaction with the non-seizure manifestations of focal epilepsy have to be considered. In women teratogenic risks associated with AED may be relevant. If complete seizure control cannot be achieved with the first three steps of AED treatment, epilepsy surgery becomes the most likely treatment modality to provide complete seizure control. It is proposed that AED combination treatment should be limited to two or three agents to minimize the risk of side effects, especially negative effects on cognition. Conclusions: Recent developments in the treatment of focal epilepsy have made it easier to tailor AED therapy to patients' demographic and clinical profile.