Vocational rehabilitation of drug abusers.

Employment has been identified as an important element in the rehabilitation of drug abusers and, together with abstinence from illicit drugs and criminal involvement, is frequently used as a criterion of treatment outcome. The research literature for the last 20 years on variables affecting employment and the vocational rehabilitation of drug abusers is reviewed with an emphasis on (a) the identification of variables influencing the employment of drug abusers and (b) the evaluation results of interventions that have been developed for this purpose. It is concluded that a number of programs have been demonstrated to have had some success in the vocational rehabilitation of drug abusers. Specific recommendations are made concerning both the direction of further research in this area and the application of existing knowledge in current practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diagnostic interviewing with drug abusers.

Principles of diagnostic interviewing with adult male drug abusers are discussed in the light of changing concepts of addiction/dependency, confidentiality, and countertransference, and basic research relevant to each major content section is highlighted. A case example illustrates these ideas, and the article concludes with some practical recommendations for interviewing substance abusers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drug preferences of multiple drug abusers.

Attempted to develop a reliable measure of preferences among types of controlled drugs, and examined the correspondence between the most preferred drug and the drug most frequently used. 130 17–29 yr old active multiple drug abusers rated their preferences among 11 combinations of controlled drugs and common methods of administration (e.g., smoking marihuana, snorting cocaine, shooting cocaine, injesting amphetamines, shooting amphetamines) using the method of paired comparisons. Edwards' coefficient of consistency indicated that preferences were highly consistent (.92) and therefore internally reliable. Nearly half of the Ss most preferred drugs other than the type that they most frequently used, and their preferences were related to the method of administration. Results suggest that preference is one of several determinants of drug use. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial correlates of empirical types of multiple drug abusers.

Drug use and psychosocial data were collected from 440 clients, average age 30.5 yrs, in 4 drug and alcohol treatment programs. Ss were administered the Buss-Durkee Hostility Inventory, the Guilt Inventory, the Social Readjustment Rating Scale, a self-concept measure and 34 other psychosocial scales. A cluster analysis was performed on chronicity/frequency indices that had been calculated for each of 15 drug classes. Four multiple drug clusters were identified: (a) cocaine/other opiates and synthetics/methaqualone/illegal methadone; (b) inhalants/codeine/nonnarcotic analgesics; (c) marihuana/amphetamines/hallucinogens; (d) minor tranquilizers/barbiturates. Heroin and alcohol did not cluster with any other substances but were frequently used by this sample, and consequently were retained in further analyses, yielding 6 basic drug clusters. Next, a typology of drug abusers was developed empirically by means of proximity cluster analysis. Eight quantitatively and qualitatively distinct types of multiple drug abusers were identified solely by analysis of their standing on the use of the 6 basic clusters of drugs. Finally, the set of psychosocial measures was found to be differentially related to use of the 6 types of drugs and to the 8 types of drug abusers. These differential findings are discussed in terms of the adequacy of the theory underlying the measures and in terms of alternative analytic strategies. (42 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal and emotional problem solving among narcotic drug abusers.

"Real-life" interpersonal and emotional problem solving was measured in 40 narcotics abusers in ambulatory treatment, 20 in "good" standing and 20 in "poor" standing. A modified means–ends problem-solving procedure was used that required narrative responses containing relevant means (RMs) for solving 7 problems. Good Ss had more total RMs, used more introspective and emotional RMs, were better at RM recognition, but did not have more sufficient narratives than the poor Ss. Results are consistent with those of previous studies of problem-solving thinking. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring effects of a skills training intervention for drug abusers.

Examined the effectiveness of a supplemental skills training and social-network-development aftercare program with 130 drug abusers (aged 15–55 yrs) from 4 residential therapeutic communities. The program included training in assertiveness, problem-solving, stress management, and giving and receiving praise; training techniques included group discussion, modeling, role playing and feedback. Pre- and posttesting with a problem situation inventory showed that the intervention produced positive effects on Ss' performance at the conclusion of treatment. Performance improved in situations involving avoidance of drug use, coping with drug relapse, social interaction, interpersonal problem solving, and coping with stress. It is concluded that as a reentry strategy, the supplemental intervention is an effective adjunct to residential treatment. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive efficiency in alcoholics and polysubstance abusers: Family history revisited.

The primary aim of this study was to evaluate the role of family history (FH) on cognitive efficiency by means of 4 different FH classification schemes. Sixty alcoholics, 64 polysubstance abusers, and 67 controls participated. No effects of FH were found for any of the 4 FH classification strategies. However, main effects of group were found, providing evidence that the clinical samples were representative of those from previous studies. These data support those of other investigators and suggest that having an FH of alcoholism cannot account for cognitive impairment among chronic alcoholics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Abstinence-contingent reinforcement and engagement in non-drug-related activities among illicit drug abusers.

Methadone-maintained cocaine abusers (N = 78) were randomly assigned to 1 of the following 52-week interventions: (a) usual care only (UC), (b) take-home methadone doses contingent on cocaine- and opiate-negative results (THM), or (c) take-home methadone doses for cocaine- and opiate-negative results and monetary-based vouchers contingent on cocaine-negative urinalysis results (THM + V). Cocaine use was assessed by urinalysis on a thrice-weekly schedule. Frequency and enjoyability of non-drug-related activities were assessed with the Pleasant Events Schedule (PES) at baseline, midtreatment, and end of treatment. The THM + V condition achieved the greatest abstinence from cocaine and opiate use, followed by the THM and UC conditions. The THM + V condition had the highest PES frequency ratings at midtreatment and at the end of treatment, followed by the THM and UC conditions. There were significant differences between the THM + V and UC conditions on 10 of 12 PES-derived subscales. Analyses revealed that abstinence mediated the effects of treatment condition on frequency ratings. There were no significant differences in enjoyability ratings. These results suggest that when contingency-management interventions increase abstinence from drug abuse, they also increase engagement in non-drug-related activities in naturalistic settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Addressing HIV risk behavior among pregnant drug abusers: An overview.

Both sex- and drug-related HIV risk behavior are common among pregnant drug abusers. In the absence of intervention, these behaviors are likely to continue throughout pregnancy, placing the women and their unborn children at risk of contracting HIV. Drug treatment programs have been found to have limited impact on these behaviors. Although certain drug risk behaviors have been shown to decrease during drug treatment, sex-related risk behavior remains largely unaffected. Similarly, knowledge- and skill-based HIV risk reduction interventions have demonstrated modest efficacy. Therefore, there is a need to develop new interventions that directly target sex- and drug-related HIV risk behavior among pregnant drug abusers, taking advantage of a period in the women's lives in which the potential negative consequences of risk behavior are more significant given the possible impact on their unborn children and in which there may be a heightened desire to make healthier behavior choices. Recent work suggests that a promising new direction for the field may be incorporating motivational interviewing components into traditional HIV risk reduction interventions, which focus on providing HIV risk information and building sex- and drug-related HIV risk reduction skills. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Skills training for drug abusers: Generalization, maintenance, and effects on drug use.

This study reports on the follow-up data for the treatment of drug abuse by J. D. Hawkins et al (see record 1987-08465-001). In the original study, 130 clients in the reentry phase of residential drug treatment programs were randomly assigned to a control group (n?=?60) or to a 10-week supplemental behavioral skills training course (n?=?70). Eighty-two percent of the sample was male, and 75% was White. Subjects' ages ranged from 15 to 55 years, though the majority (71%) were in their twenties. A role-play test assessing skill levels was administered as a pretest, following the 10-week skill training course, and again at 6 and 12 months as follow-ups. Although skills decayed slightly over time, the skill levels of experimental subjects were higher than the control group 12 months after training. Generalization of skills to role-play situations for which no training had been received was also found. However, with the exceptions of marijuana and amphetamine use, skill training did not affect drug use after treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special series: HIV infection among drug abusers.

Drug users are particularly at risk for contracting the human immunodeficiency virus and serve as a major mechanism for spreading the virus to other sectors of the population. As a result drug abuse treatment and potential behavioral change strategies are primary public health issues. The purpose of this article is to review the contributions included in this special edition, which represent an effort to describe the most current thinking in the field with a blend of theoretical, review, and empirical articles. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist adherence in brief strategic family therapy for adolescent drug abusers.

Objective: Therapist adherence has been shown to predict clinical outcomes in family therapy. In prior studies, adherence has been represented broadly by core principles and a consistent family (vs. individual) focus. To date, these studies have not captured the range of clinical skills that are represented in complex family-based approaches or examined how variations in these skills predict different clinically relevant outcomes over the course of treatment. In this study, the authors examined the reliability and validity of an observational adherence measure and the relationship between adherence and outcome in a sample of drug-using adolescents who received brief strategic family therapy within a multisite effectiveness study. Method: Participants were 480 adolescents (age 12–17) and their family members, who were randomized to the Brief Strategic Family Therapist treatment condition (J. Szapocznik, U. Hervis, & S. Schwartz, 2003) or treatment as usual. The adolescents were mostly male (377 vs. 103 female) and Hispanic (213), whereas 148 were White, and 110 were Black. Therapists were also randomly assigned to treatment condition within agencies. Results: Results supported the proposed factor structure of the adherence measure, providing evidence that it is possible to capture and discriminate between distinct dimensions of family therapy. Analyses demonstrated that the mean levels of the factors varied over time in theoretically and clinically relevant ways and that therapist adherence was associated with engagement and retention in treatment, improvements in family functioning, and reductions in adolescent drug use. Conclusions: Clinical implications and future research directions are discussed, including the relevance of these findings on training therapists and studies focusing on mechanisms of action in family therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual behaviour and multiple infections in drug abusers

We have studied the prevalence and the serological profile of HBV, HCV, HDV and HIV infections in 137 Italian subjects addicted to the intravenous use of heroine and correlated the virological findings with sexual behaviour. HBV and HCV viremia were also measured in 114 patients. Anti-HCV was detected in 81% of the addicts, and one or more markers of HBV infection were detected in 62.8% (4.4% were carriers of HBsAg, 58.4% had evidence of past HBV infection and 13.1% of the latter also had HDV markers). Anti-HIV was positive in 23.4%; 26% of those positive for anti-HCV and 4.6% of those positive for HBV markers had no other viral marker: none had only anti-HIV. HBV-DNA was negative in the carriers of HBsAg, and HCV-RNA was not detected in any of the HBsAg carriers who also had circulating anti-HCV. Overall, 34% of the anti-HCV positive addicts had HCV-RNA in their blood. The prevalence of the virus infection correlated with the duration of drug addiction but not with sexual behaviour, and sexual behaviour did not influence the acquisition of any virus. HCV infection was most frequent and probably the first infection to occur, but exposure to HBV was also common despite a low rate of HBsAg carriage. The prevalence of HDV infection was high (50%) in the HBsAg carriers, while the overall prevalence of HIV was lower (23%) than expected. Lack of HBV-DNA and HCV-RNA in carriers of HBV with anti-HCV in serum may indicate that HBV and HCV mutually inhibit their own replication.     

Criminality in a sample of drug abusers in Greece

In order to produce mAbs directed specifically against HLA-DR10 molecule, transfected mouse L cells, expressing the DRB1*1001 allele, were used to immunize C3H mice over a period of 4 weeks. Two mAbs, 2C12 and 4B6, derived from this fusion were found to recognize, with different affinity, polymorphic epitopes of DR10 that are shared with DR1, 3, 7, and 9. These mAbs were screened on a large panel of homozygous B lymphoblastoid cell lines using microlymphocytotoxicity and the results were confirmed by flow cytometry. The reactive pattern of 2C12 and 4B6 was compared to that of MP10 human mAb also recognizing the DR10 specificity in addition to DR1, 2 and 9. Based on serologic specificity and cellular absorption experiments, we conclude that the epitopes the murine and human mAbs respectively recognize on the DR10 molecule, are probably different.