Multisystemic Treatment of Substance-Abusing and -Dependent Delinquents: Outcomes,Treatment Fidelity,and Transportability

The effectiveness and transportability of multisystemic therapy (MST) were examined in a study that included 118 juvenile offenders meeting DSM-III-R criteria for substance abuse or dependence and their families. Participants were randomly assigned to receive MST versus usual community services. Outcome measures assessed drug use, criminal activity, and days in out-of-home placement at posttreatment (T2) and at a 6-month posttreatment follow-up (T3); also treatment adherence was examined from multiple perspectives (i.e., caregiver, youth, and therapist). MST reduced alcohol, marijuana, and other drug use at T2 and total days in out-of-home placement by 50% at T3. Reductions in criminal activity, however, were not as large as have been obtained previously for MST. Examination of treatment adherence measures suggests that the modest results of MST were due, at least in part, to difficulty in transporting this complex treatment model from the direct control of its developers. Increased emphasis on quality assurance mechanisms to enhance treatment fidelity may help overcome barriers to transportability.     

Interactive risk factors for treatment adherence in a chronic psychotic disorders population

This study identified the unique and primary contributions of several concurrent risk factors for poor adherence to treatment recommendations in a clinic population of individuals with chronic psychotic disorders, i.e. 48% had DSM-IV diagnoses of schizoaffective disorder, 38% had schizophrenia, paranoid type, 12% had schizophrenia, undifferentiated type, and 2% had affective disorder with psychotic features. The target cohort consisted of 87 consecutive admissions to a continuing day treatment program. As part of a services-oriented quality assurance program, clinical staff completed rating scales for all patients. These included the BASIS-32 rating scale, which consisted of the following five subscales: psychosis; depression/anxiety; impulsive/addictive behavior; relation to self and others; and daily living and role functioning, and the Working Alliance Inventory-short form (therapist version), which consisted of the following three subscales: goal; task; and bond. These data were used to identify risk factors that weaken a patient's adherence to medication and non-medication treatment during the first 2 weeks of treatment in the clinic. Medication treatment consisted of both typical and atypical neuroleptic medications, with most patients being on multiple medications. Correlational analyses suggested that many of the risk factor variables were significantly associated with poor treatment adherence. Regression analyses suggested that the degree of psychoticism was most strongly associated with poor adherence to medication treatment and that difficulties relating to self and others were the strongest predictor of poor adherence to non-medication treatment. A large-sample services research design such as this can begin to determine patterns of associations between previous identified risk factors and poor treatment adherence in individuals with chronic psychotic disorders.     

Treating children and adults: whose body is it anyway?

Summary This essay, about the concept of treatment, is written by a psychiatrist who is monitoring extreme treatment situations, namely surgical treatment of epilepsy. It challenges the implicit assumption that persons consulting doctors necessarily want to be treated. A child may not be privy to, or wish to be party to, a treatment. The child, or the parent on behalf of the child, may not agree to the course of action that is in its best interest. One problem of treatment concerns who owns the body that is to be treated. Ultimately, the body belongs to the state and is merely tenanted by the child and managed by a parent on the state's behalf. But the body must, somehow, be owned if its sickness is to be acknowledged. The lack of real autonomy provides for the possibility of abuse including abusive therapies. “Abuse” is applicable only to abuse of trust. Autonomy is granted or conceded by parents and by the state but is never complete. Autonomy is confirmed by taking informed decisions about what will happen to the body. Treatment is a cost/benefit deal in which the precise aim to be achieved has to be described and accepted before treatment begins. Accepted: 8 March 1999     

Needs for Youth Substance Abuse and Violence Prevention in Schools and Communities

Substance abuse and violence among today's youth are at an all time high. Numerous prevention programs have been implemented to address these issues. Not all are successful. Research has found that when schools and communities are involved in the planning of prevention programs, youth are more cognizant of risk factors and of behaviors that strengthen risk factors. The purpose of this study was to assess the emerging needs for prevention and health education among youth, and to identify effective approaches for prevention program development and service delivery in schools and communities. This study surveyed 312 youth prevention specialists, school and community health educators and counselors, and parents in a regional sample of ten states. Results indicated that substance abuse and violence are the two most critical and priority issues in need of comprehensive prevention. Multiple prevention service delivery strategies appropriate to youth, including training, technical assistance, conferencing and networking, needs assessment and evaluation, and information requests are discussed in detail. Implications for prevention programming emphasized reducing risk factors and strengthening protective factors, reaching and motivating youth participation.     

Workplace Drug Abuse Prevention Initiatives: A Review

Likely key elements of effective prevention strategies emerging from the literature (and from discussions with experts) are summarized. These include: (1) program content based on proven prevention theory and research; (2) comprehensive approaches that address multiple risk and protective factors, and generalize across settings; (3) material that is relevant during important transitions in an employee's life and career (4) sensitivity to the culture of the workplace and community; (5) sufficient dosage and follow-up; (6) use of interactive teaching techniques; (7) training for prevention program providers; and (8) evaluation to know that the intervention had the desired effect on behavior. Evaluation of workplace substance abuse prevention has been limited; the need for future research is discussed. The paper concludes with a discussion of how to increase interest in substance abuse prevention by employers.     

反复心理应激对大鼠儿茶酚胺和酪氨酸代谢的影响

采用ＣｏｍｍｕｎｉｃａｔｉｏｎＢｏｘ大鼠模型研究了反复心理应激对大鼠儿茶酚胺（ＣＡ）和酪氨酸（Ｔｙｒ）代谢的影响,及补充Ｔｙｒ的作用。实验发现：反复心理应激使心理应激组（Ｓ组）和心理应激补充Ｔｙｒ组（ＳＴ组）第１、３、７ｄ２４ｈ尿ＣＡ排出量高于对照组（Ｃ组）（Ｐ＜００５）;而第１４ｄＳＴ组血浆和脑匀浆Ｔｙｒ含量分别高于Ｓ组和Ｃ组（Ｐ＜００１）。反复心理应激７ｄ时,Ｓ组大鼠旷场试验得分低于Ｃ组（Ｐ＜００５）,产生行为缺陷,而补充Ｔｙｒ使ＳＴ组大鼠旷场试验得分降低有所减轻。     

Impulsivity and cigarette smoking: delay discounting in current, never, and ex-smokers

Rationale: Impulsivity is implicated in drug dependence. Recent studies show problems with alcohol and opioid dependence are associated with rapid discounting of the value of delayed outcomes. Furthermore, discounting may be particularly steep for the drug of dependence. Objectives: We determined if these findings could be extended to the behavior of cigarette smokers. In particular, we compared the discounting of hypothetical monetary outcomes by current, never, and ex-smokers of cigarettes. We also examined discounting of delayed hypothetical cigarettes by current smokers. Methods: Current cigarette smokers (n=23), never-smokers (n=22) and ex-smokers (n=21) indicated preference for immediate versus delayed money in a titration procedure that determined indifference points at various delays. The titration procedure was repeated with cigarettes for smokers. The degree to which the delayed outcomes were discounted was estimated with two non-linear decay models: an exponential model and a hyperbolic model. Results: Current smokers discounted the value of delayed money more than did the comparison groups. Never- and ex-smokers did not differ in their discounting of money. For current smokers, delayed cigarettes lost subjective value more rapidly than delayed money. The hyperbolic equation provided better fits to the data than did the exponential equation for 74 out of 89 comparisons. Conclusions: Cigarette smoking, like other forms of drug dependence, is characterized by rapid loss of subjective value for delayed outcomes, particularly for the drug of dependence. Never- and ex-smokers could discount similarly because cigarette smoking is associated with a reversible increase in discounting or due to selection bias. Received: 3 March 1999 / Final version: 11 May 1999     

Programmes for tobacco and alcohol users in Australian work-places

This article presents findings from a survey of programmes available for tobacco and alcohol users working in 455 of Australia's top 600 companies. Companies were twice as likely to have programmes for smokers (43%) as for problem drinkers (24%) and these programmes were more apparent in large companies. The majority of programmes for smoking were delivered within a health promotion context which included other life-style issues, such as nutrition, exercise, weight management and stress management. Although Employee Assistance Programs (EAPs) were the most commonly available type of work-place programme for excessive drinkers and other drug users, followed by Alcoholics Anonymous and local hospital clinics, only 6% had an EAP for alcohol. Only 21% of programmes for smokers and 12% for excessive alcohol users were evaluated. Around one-quarter of companies knew the costs of smoking programmes, and 9% reported costs of conducting programmes for excessive alcohol consumers.