Brief coping skills treatment for cocaine abuse: 12-month substance use outcomes.

Patients (N?=?108) in a study of cocaine-specific coping skills training (CST), which was found to reduce cocaine use during a 3-month follow-up, were followed for an additional 9 months. CST involved coping skills training in the context of high-risk situations. Control treatment used meditation-relaxation. Both were added to comprehensive private substance abuse treatment. Patients in CST who relapsed had significantly fewer cocaine use days than did the control group during the first 6 months, then both conditions did equally well. Patients in CST also drank alcohol more frequently in the last 6 months than did contrast patients but did not differ in heavy drinking days. For cocaine use outcomes, no interaction of treatment was found with gender, education, route of administration, drug use severity, sociopathy, or depression. Implications include the need to investigate different lengths and combinations of treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pythium insidiosum keratitis

Dopamine deficiency is found in both chronic cocaine abusers and Parkinson's disease. The authors sought to determine whether parkinsonian signs occur in chronic cocaine abusers. Fifty male patients with a history of chronic heavy cocaine abuse were examined on the Unified Parkinson Disease Scale (UPDS) and compared with 20 non-cocaine-abusing, age- and sex-matched control subjects. UPDS scores of cocaine abusers ranged from 0 to 1 (mean: 0.08 +/- 0.28) and, in control subjects, from 0 to 3 (mean: 0.15 +/- 0.49; P = 0.5; NS). This study suggests that chronic heavy cocaine abuse does not cause parkinsonism.     

Cocaine abusers with and without alcohol dependence respond equally well to contingency management treatments.

Contingency management (CM) treatments are efficacious in treating cocaine abuse. Despite high prevalence rates of alcohol dependence (AD) among individuals with cocaine use disorders, relatively little data are available regarding whether comorbid AD is associated with poorer treatment outcomes in general, or in response to CM in particular. Using data from 3 randomized trials of CM for cocaine abuse, we compared cocaine abusers (N = 393) with and without AD in terms of abstinence and psychosocial problems during treatment and follow-up. Alcohol dependent participants had more lifetime years of cocaine and alcohol use and greater severity of alcohol and psychiatric problems. CM was positively and significantly associated with longer durations of abstinence, regardless of AD status. Although not significantly associated with abstinence, the presence of AD was related to improvement in medical and alcohol-related problems during treatment, and these gains were maintained posttreatment. The results suggest that cocaine abusers benefit equally well from CM treatments, regardless of AD status. Further, alcohol dependent participants are able to offset greater baseline severity in psychosocial functioning and maintain these improvements with CM. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of the frequency and enjoyability of pleasant events in cocaine abusers vs. non-abusers using a standardized behavioral inventory

AIMS: To examine whether cocaine abusers differ from non-abusers in their frequency and enjoyability of engaging in various "pleasant events", in order to approximate the density of positive reinforcement experienced in their natural environment. DESIGN: Comparisons of cocaine abusers to normative data and matched controls. SETTING: An outpatient substance abuse treatment center in Burlington, Vermont, USA. PARTICIPANTS: Subjects included 100 individuals enrolled in outpatient treatment for cocaine abuse or dependence and 50 community volunteers without histories of drug abuse or other major psychiatric illness and matched to cocaine-dependent patients on age, sex and SES. MEASUREMENTS: Diagnostic assessments were based upon clinical interviews using the DSM-III-R checklist. The primary focus of this study was the Pleasant Events Schedule (PES), a self-rated behavioral inventory of the frequency and enjoyability of engaging in "pleasant" activities. Cocaine use history, treatment outcome and other relevant variables were also assessed. FINDINGS: Cocaine abusers reliably reported lower frequency of non-social, introverted, passive outdoor and mood-related activities than controls. These differences remained after controlling for demographic and life-style differences between groups, with the exception of mood-related activities. Perceived enjoyability of the activities did not differ across groups. Intravenous cocaine use and prior treatment for cocaine abuse predicted particularly low frequency of pleasant activities. Greater frequency of non-social activities predicted better treatment outcome. CONCLUSIONS: Drug abuse is associated with low density of certain types of non-drug reinforcement. Systematic increases in these activities may improve treatment outcome.     

Efficacy of brief coping skills interventions that match different personality profiles of female substance abusers.

Female substance abusers recruited from the community were randomly assigned to receive 1 of 3 brief interventions that differentially targeted their personality and reasons for drug use. The 90-min interventions were: (a) a motivation-matched intervention involving personality-specific motivational and coping skills training, (b) a motivational control intervention involving a motivational film and a supportive discussion with a therapist, and (c) a motivation-mismatched intervention targeting a theoretically different personality profile. Assessment 6 months later (N?=?198) indicated that only the matched intervention proved to be more effective than the motivational control intervention in reducing frequency and severity of problematic alcohol and drug use and preventing use of multiple medical services. These findings indicate promise for a client-treatment matching strategy that focuses on personality-specific motives for substance abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping Skills Training and 12-Step Facilitation for Women Whose Partner Has Alcoholism: Effects on Depression, the Partner's Drinking, and Partner Physical Violence.

Women (N = 171), distressed from their partners' untreated alcoholism, received either coping skills training (CST), 12-step facilitation (TSF), or delayed treatment (DTC). CST and TSF resulted in lower depression levels than DTC but did not differ from one another. Skill acquisition mediated the treatment effects of CST; Al-Anon attendance did not mediate the TSF effect. Lower depression levels were maintained at 12 months with no differences between groups. Partner drinking decreased from pretreatment to follow-up in the CST and TSF conditions. However, for partners with a history of relationship violence, drinking improved across follow-up in the CST condition but worsened in the TSF condition. Partner relationship violence was less in the CST condition. CST may be particularly useful for women experiencing physical violence from a partner with alcoholism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sensation seeking, substance abuse, and psychopathology in treatment-seeking and community cocaine abusers.

Sensation seeking, substance abuse severity, and psychiatric disorders were systematically assessed in a clinical and a community sample of 335 cocaine abusers. In contrast to low-sensation-seeking cocaine abusers, high-sensation seekers exhibited more severe symptoms of substance abuse, exhibited more severe psychosocial impairment, were more likely to be polysubstance abusers, and had an earlier age of onset for substance use and abuse. High-sensation seekers were more likely to report both a lifetime history and family history of antisocial personality, attention deficit disorders and conduct disorder. Sensation seeking was related to several dimensions that are important for defining subtypes of substance abusers and was consistent with other features of a Type II classification. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cue exposure with coping skills treatment for male alcoholics: A preliminary investigation.

Although early investigations were promising, no controlled follow-up studies have investigated the effectiveness of cue exposure treatment for alcoholics. In this study, inpatient alcoholics received either cue exposure integrated with urge coping skills training (CET; n?=?22) or a contrast condition (CC) involving daily contact with assessment only (n?=?18) in addition to standard treatment. Comprehensive assessment measures were used to investigate change in process and outcome variables. In the 2nd 3 mo after treatment, the CET group included more patients who were completely abstinent, had a higher percentage of abstinent days, and tended to report fewer drinks per day than did patients in the contrast condition. The significantly greater use of coping skills during follow-up by the CET group and the significant relationship of these coping skills to decreased drinking suggest that treatment effects were due, at least in part, to the coping skills training, consistent with recent formulations. Theoretical and treatment implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of coping skills training on adolescents at risk for substance use.

279 high-risk secondary school students completed one of the following treatment conditions: (1) coping skills school intervention, (2) coping skills school plus parent intervention, or (3) comparison control. Ss in the coping skills conditions improved on a measure of coping skills acquisition, whereas those in the control group did not. All Ss improved on a variety of personality and school behavior variables. There were some modest increases in self-report of substance use; however, these were smaller than would be expected in a high-risk population over the study period. The findings suggest that preventive intervention with high-risk youth has some positive effect on risk factors, although the differential efficacy of coping skills training with high-risk youth was not supported. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy for cocaine addiction.

Cocaine abuse continues to be a major public health problem. Drug abuse researchers and practitioners have developed theoretically diverse cocaine-specific psychological treatments, including behavioral and cognitive–behavioral therapies, psychodynamic therapies, and integrative outpatient programs. In 1991, a major literature review identified several promising approaches, but there was little empirical evidence for their efficacy (R. A. Rawson, J. L. Obert, M. J. McCann, F. G. Castro, & W. Ling, 1991). Since then, outpatient psychotherapies for cocaine addiction have increasingly been empirically evaluated. This article summarizes prominent current approaches, with emphasis on empirical studies that have appeared since the Rawson et al. (1991) review, and evaluates progress in the field. Studies of treatment retention and the effect of comorbid psychopathology on treatment response are reviewed, and directions for future research are proposed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relapse prevention strategies in outpatient substance abuse treatment.

Reviews the use of relapse prevention (RP) strategies in the treatment of substance abuse disorders. The work of G. A. Marlatt and J. R. Gordon (1980, 1985) provided the cognitive-behavioral base of RP models and numerous techniques. Specific protocols for the treatment of alcoholism, cocaine abuse, marijuana abuse, and heroin addiction are described. This body of knowledge has given the drug-free outpatient treatment of substance abuse a clear focus and direction. The techniques used in the RP include 7 groups of strategies: psychoeducation, identification of high-risk situations for relapse, development of coping skills, development of new-life behaviors, increased self-efficacy, dealing with relapse and avoiding the abstinence violation effect, and drug and alcohol monitoring. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

PET study of competition between intravenous cocaine and [11C]raclopride at dopamine receptors in human subjects

OBJECTIVE: Animal data suggest that the strong euphoriant effects of cocaine are related to the drug's enhancement of available dopamine at the synaptic cleft. The authors' goal was to determine whether this mechanism is the same in humans because the development of putative pharmacological agents for treatment of cocaine dependence depends on this knowledge. METHOD: Positron emission tomography with [11C]raclopride was used to examine the effects of the intravenous administration of 48 mg of cocaine (a typical "street" dose) on the occupancy of dopamine 2 receptors in the putamen of 11 self-identified intravenous drug abusers. RESULTS: All 11 subjects reported subjective stimulation and euphoria in response to cocaine administration. Radioligand occupancy at dopamine receptors was decreased significantly after cocaine administration, suggesting that higher dopamine concentrations were competing at the receptor site. CONCLUSIONS: These results support the concept of dopamine system involvement in human cocaine abuse.     

Coping strategy use following computerized cognitive-behavioral therapy for substance use disorders.

Coping strategies are emerging as a predictor of treatment outcome for substance users and may be particularly important among computerized and self-change approaches. We used data from a randomized clinical trial of a computer-based version of cognitive–behavioral therapy (CBT4CBT) to: (1) examine the association between observer ratings of coping skills and self-reported coping strategies; (2) evaluate whether participants assigned to the CBT4CBT program reported greater use of coping strategies compared with those not exposed to the program; and (3) examine the differential effect of coping strategies by treatment group on drug-related outcomes. Individuals (N = 77) seeking treatment for substance dependence at a community-based outpatient substance abuse treatment facility were recruited and randomized to receive treatment-as-usual (TAU), or TAU plus CBT4CBT, with the Coping Strategies Scale administered at baseline and posttreatment. Self-reported coping strategy use was strongly correlated with observer ratings on a role-play assessment of coping skills. Although no significant group differences were found across time for coping strategy use, results suggested that as coping strategy use increased, drug use decreased, and this relationship was stronger for participants who received CBT4CBT. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Aggression and hostility in substance abusers: the relationship to abuse patterns, coping style, and relapse triggers

A cohort of 3,367 substance abusers seeking treatment were administered measures of aggression and hostility including the Buss-Durkee Hostility Inventory and the NEO Personality Inventory Hostility Scale. Polysubstance abusers scored significantly higher on all measures of hostility and aggression, regardless of whether they abused cocaine or not. Subjects scoring higher on aggression and hostility utilized escape-avoidance, distancing, and confrontational coping styles more regularly. Subjects scoring higher on measures of aggression and hostility reported more situations that triggered their use of substances and less confidence that they could resist using when faced with such situations in the future. This was especially true for situations involving unpleasant internal states, situations involving rejection, and situations involving conflict with family and friends. The implications of these findings for clinical assessment and treatment planning are discussed.     

Coping skills and treatment outcomes in cognitive-behavioral and interactional group therapy for alcoholism.

In the present study 128 alcohol dependent men and women received 26 weeks of group treatment in one of two modalities: Cognitive-behavioral treatment (CBT) intended specifically to develop coping skills or interactional therapy intended to examine interpersonal relationships. Coping skills and drinking were assessed prior to and after treatment and up to 18 months after intake. Results indicated that both treatments yielded very good drinking outcomes throughout the follow-up period. Increased coping skills was a significant predictor of outcome. However, neither treatment effected greater increases in coping than the other. Specific coping-skills training was not essential for increasing the use of coping skills. The results raise questions about the efficacy of specific treatment elements of CBT in treatment of alcohol dependence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Subtypes of cocaine abusers: Support for a Type A–Type B distinction.

The dysfunction and generalizability of a multidimensional alcoholism typological system was systematically assessed in 399 inpatient, outpatient, and non-treatment-seeking cocaine abusers. Two different cluster-analytic procedures supported the construct, concurrent, and predictive validity of the Type A–Type B distinction in cocaine abusers. Participants classified as Type B (33%) cocaine abusers exhibited higher rates of premorbid risk factors (family history, childhood behavior problems, personality, age of onset), more severe drug and alcohol abuse, more addiction-related psychosocial impairment, more antisocial behavior, and more comorbid psychiatric problems than Type A participants (67%). Multidimensional typological systems have had a major impact on the alcoholism field and may be equally important for the assessment, prevention, treatment, and theoretical understanding of other substance use disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Autism and visual agnosia in a child with right occipital lobectomy

Situational factors are important determinants of alcohol and drug use in general samples of substance abusers, with alcohol users and drug users reporting different trigger situations. This study represents an initial attempt to investigate high-risk alcohol and drug use situations in a sample of dually diagnosed individuals. Thirty men and women with both a serious mental illness and an alcohol use or drug use disorder were recruited from an inpatient psychiatric unit and completed questionnaires assessing high-risk alcohol and drug use situations psychiatric symptomatology, and psychological symptoms that trigger substance use. Although the alcohol and drug groups did not differ significantly in the frequency of self-reported high-risk situations for substance use, effect size analyses suggest that six of eight comparisons would demonstrate statistically significant differences with a larger sample size. Both groups reported using substances most frequently when feeling anxiety or depressive symptoms rather than psychotic symptoms. Although preliminary, these results have relevance for the treatment of dually diagnosed persons, particularly for behavioral treatment interventions such as coping skills training and stimulus control techniques.     

Component analysis of occupational stress inoculation applied to registered nurses in an acute care hospital setting.

The stress inoculation (SI) paradigm, which consists of education (ED), coping skills training (CST), and exposure to simulated stressors (EX), was applied to the occupational stress experienced by nurses. Occupational stress was operationally defined in terms of 13 dependent measures reflecting problem areas summarized by the acronym ReACT (retrograde complaints, assertiveness deficits, competency concerns, and time stress). ReACT also stood for the ingredients of the CST component (relaxation training, assertive skill building, cognitive restructuring, and time management instruction). To determine which SI components produce a treatment effect, 60 White female acute-care registered nurses (mean age 33.8 yrs) were randomly assigned to 1 of 4 active treatment cells: SI, CST, EX, ED, or no treatment (NT). Ss were administered a battery of tests that included the State–Trait Anxiety Inventory and Rathus Assertiveness Schedule. A MANOVA at posttest, and subsequent univariate analyses simultaneously considering 4-mo follow-up data, demonstrated that SI is an effective treatment with durable benefits and that CST is its principal ingredient. Additional demand-characteristics analyses indicated that these effects are not due to placebo-related phenomena. (54 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social skills and cognitive-relaxation approaches to general anger reduction.

Inductive social skills training (ISST), skill assembly social skills training (SASST), and cognitive relaxation coping skills (CRCS) training were compared with a no-treatment control condition for general anger reduction. At 4-wk follow-up, compared with the control group, all treatment groups showed equivalent reductions of the amount of anger experienced in a wide range of situations. ISST and CRCS Ss reported less anger in their worst ongoing provocation than did control Ss, whereas SASST Ss did not differ from Ss of other groups. Treatment groups enhanced anger control equally relative to the control group, but only the CRCS group significantly lowered outward, negative expression of anger, and only the ISST group reduced anger suppression, although active treatment groups did not differ from one another on these measures. The ISST group lowered day-to-day anger more than other groups. No treatment effects were found for nontargeted trait anxiety and assertiveness. Results are discussed in terms of prior findings and the efficacy and flexibility of ISST. (PsycINFO Database Record (c) 2010 APA, all rights reserved)