Depression among cocaine abusers in treatment: relation to cocaine and alcohol use and treatment outcome

Recent studies indicate that immature B cells compete with recirculating B cells for survival signals. The signals, delivered through the B-cell receptor for antigen, induce immature cells to differentiate into recirculating cells and maintain the survival of recirculating cells. They do not induce proliferation or differentiation to antibody-producing cells.     

Mediators of outcome of psychosocial treatments for cocaine dependence.

This study examined endorsement of 12-step philosophy and engagement in recommended 12-step activities as a mediator of the outcomes of individual plus group counseling for cocaine dependence. Assessments of drug use outcomes and the mediator were made at baseline and monthly for 6 months. Engagement in recommended 12-step activities was found to be a partial statistical mediator of drug use outcomes of individual (plus group) drug counseling, but no evidence for change in the mediator preceding change in drug use was found. In addition, a measure of beliefs about addiction developed to test mediation of outcome of cognitive therapy was found to correlate moderately with drug use outcomes in both cognitive therapy and individual drug counseling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group treatment of depression: Individual predictors of outcome.

The present study attempted to identify patient characteristics predictive of individual outcome in a psychoeducational group treatment for unipolar depression. Forty participants meeting Research Diagnostic Criteria for depressive disorders were assessed on demographic and psychological variables at both pre- and posttreatment and on participation variables during treatment. The treatment modality was the Coping With Depression Course. At the end of treatment, 85% of the subjects no longer met diagnostic criteria for depressive disorders. A stepwise multiple regression analysis attained a multiple correlation of .92, accounting for 85% of the variance in posttreatment depression level. Ten variables accounted for significant portions of the outcome variance beyond that explained by pretreatment Beck Depression Inventory scores. The results of previous studies were partially replicated; predictive ability was improved markedly over prior reports. The results suggest that the most robust predictors of outcome are pretreatment levels of depression, social functioning, perceived mastery over events, and early positive perceptions of group cohesiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outpatient behavioral treatment for cocaine dependence: One-year outcome.

This article describes outcomes observed during the year after treatment entry from two controlled trials in which cocaine-dependent outpatients were randomly assigned to either a multicomponent behavioral treatment or to one of two control treatments. The behavioral treatment integrated the community reinforcement approach (CRA) with an incentive program in which cocaine abstinence was reinforced with vouchers exchangeable for retail items. The two control treatments were drug abuse counseling and CRA without the incentive program. All treatment groups improved significantly compared to intake, and those changes were maintained through the follow-up period. When efficacy differences were observed during treatment and follow-up, they supported CRA with vouchers over control treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Demographic, individual, and interpersonal predictors of adolescent alcohol and marijuana use following treatment.

A vulnerability model of adolescent substance abuse treatment outcome provided the basis for selection of demographic, individual, interpersonal, and treatment factors to predict the follow-up use of alcohol and marijuana in a sample of 225 adolescents (aged 12–18 yrs) with psychoactive substance use disorders. Pretreatment levels of sibling substance use and aftercare participation predicted alcohol and marijuana use during the first 6 mo posttreatment. Pretreatment levels of deviant behavior also predicted the use of marijuana at 6-mo follow-up. Peer substance use at intake and 6-mo posttreatment both predicted substance use frequency outcomes at 12-mo follow-up. Alcohol and marijuana use frequencies at 6-mo follow-up also predicted continued use for these substances throughout the remainder of the 1st posttreatment year. Shorter treatment length and being male were risk factors for alcohol use during the 2nd half of the 1st posttreatment year. Elevated psychological substance dependence at 6-mo follow-up was a unique risk factor for subsequent marijuana use. Findings support conceptual models that attempt to explain adolescent substance abuse treatment outcome in terms of relationships among demographic, individual, interpersonal, and treatment factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting cocaine group treatment outcome in cocaine-abusing methadone patients.

The authors examined predictors of cocaine group treatment outcome in methadone maintenance treatment (MMT) patients, including cocaine urinalysis at intake and demographic variables. Clinic policy is that patients identified as using cocaine must attend a weekly cocaine-focused, cognitive–behavioral therapy (CBT) group. Cocaine treatment is based on a behavioral (escape) contingency model whereby completers must attend group-counseling sessions and produce cocaine-negative urinalysis results. Among the 113 patients enrolled in the cocaine group, 43 (38%) were treatment completers (who attended 6 consecutive weeks of group and produced 6 consecutive weeks of cocaine-free urine tests) and 70 (62%) were treatment noncompleters. Treatment completion (i.e., cocaine abstinence) was significantly associated with baseline cocaine-free urinalysis and higher methadone dose. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictive validity of cocaine, sedative, and alcohol dependence diagnoses.

This study examined the predictive validity of Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) (R. L. Spitzer et al, 1990) based substance dependence diagnoses (i.e., cocaine, sedative, and alcohol) for 518 opioid-dependent outpatients entering methadone maintenance. Patients were followed over 1 year of treatment, which involved daily methadone substitution supplemented by individual and group counseling. Urine specimens were tested randomly 1–4 times per month. Patients diagnosed with current cocaine, sedative, or alcohol dependence were more likely to use these drugs than were patients with past only or no dependence syndrome. Current cocaine dependence predicted early treatment dropout. The results demonstrate the predictive and discriminant validity of several substance dependence diagnoses common among patients in substance abuse or other psychiatric treatment settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychopathology in inpatients dependent on cocaine or alcohol and cocaine.

Assessed the differences between cocaine- and cocaine-plus-alcohol-dependent inpatients along several psychological variables. Of the 144 men that served as Ss, 113 were cocaine dependent and 31 were dependent on both cocaine and alcohol (CD-AD). CD-AD Ss showed significantly more symptoms of depression and anxiety and were more likely to have antisocial and avoidant personality disorders. The CD-AD group scored higher overall on the MMPI clinical scales. Results suggest that patients dependent on both cocaine and alcohol require increased attention to psychopathology during treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group comparisons of coping self-efficacy between alcohol and cocaine abusers seeking treatment.

The Drug-Taking Confidence Questionnaire (DTCQ; H. M. Annis & G. Martin, 1985) assesses situation-specific coping self-efficacy for resisting the use of a particular substance of abuse. This article extends previous research (S. M. Sklar, H. M. Annis, & N. E. Turner, see record 1998-10850-009) by testing the factorial invariance of the DTCQ on a sample of 344 alcohol and 253 cocaine clients. The results confirmed that the 8-factor model based on G A. Marlatt and J. R. Gordon's (1985) high-risk categories for relapse provided a remarkably similar fit across both samples. Alcohol clients were less confident in their ability to resist using than cocaine clients in interpersonal conflict situations, whereas cocaine clients expressed less confidence in temptation-related situations. For both samples, women were more confident than men in positive situations. The findings demonstrate that the DTCQ is sensitive to different situational patterns of self-efficacy between alcohol and cocaine clients and between men and women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing thoughts about cocaine and their relationship to short-term treatment outcome.

Tested the relationship of intrusive and avoidant thoughts about cocaine to early treatment outcome in crack users entering inpatient treatment. As part of a study comparing the effects of desipramine (50–200 mg daily) vs placebo, 57 Ss completed a modified version of the Impact of Event Scale, the Profile of Mood States, and a craving scale. For the placebo group only, significant correlations were found between baseline intrusion scores and the 3 outcome measures at 1 wk postdischarge, including self-reported cocaine use confirmed by urinalysis. The addition of intrusion scores to craving and mood significantly improved the ability to predict whether the S was in treatment at the 1-wk follow-up assessment. For the desipramine group, intrusions were not related to outcomes. Thus, desipramine may have interrupted the neurochemical and psychological reactivity from intrusive thoughts about cocaine. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing variation in alcohol outcome expectancies across environmental context: An examination of the situational-specificity hypothesis.

Using an in vivo manipulation, this study examined whether alcohol outcome expectancies (AOEs) vary across environmental settings. Two hundred twenty-one undergraduates were randomly assigned to 1 of 4 conditions in which environmental context (an on-campus bar vs. a laboratory) and instructed phase of intoxication ("just enough to begin to feel intoxicated" vs. "too much to drink") were manipulated. AOEs were assessed with a revised version of the Effects of Alcohol Scale (L. Southwick, C. Steele, A. Marlatt, & M. Lindell, 1981). Compared with participants tested in the laboratory, individuals exposed to the on-campus bar expected greater alcohol-related stimulation/perceived dominance and pleasurable disinhibition. Women expected more behavioral impairment during the latter stage of intoxication. These findings highlight the importance of ecologically valid research in this area, as well as cue-exposure assessment and treatment approaches. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term outcome in cognitive-behavioral treatment of panic disorder: Clinical predictors and alternative strategies for assessment.

Long-term outcome (24-month follow-up; 24 MFU) of cognitive-behavioral treatment was examined in 63 patients with panic disorder. When the traditional methods of cross-sectional assessment were used (e.g., panic frequency during past month), long-term outcome findings paralleled those of earlier studies. However, assessments of idiographic response and those that examined longer time periods revealed that a large proportion of the sample experienced a fluctuating symptom course of panic-related symptomatology that was not captured by the cross-sectional method. Many (27%) patients sought further treatment for panic during the follow-up period because of a less-than-adequate response to treatment; nevertheless, additional treatment did not result in further clinical improvement. Pretreatment severity of panic disorder was associated with poorer outcome at 24 MFU. Use of psychotropic medication during treatment was associated with poorer outcome, although to a weaker degree when pretreatment responding was controlled. Findings are discussed in the context of how the outcome of treatments for panic disorder should be evaluated and interpreted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral therapy plus contingency management for cocaine use: Findings during treatment and across 12-month follow-up.

Contingency management (CM) rapidly reduces cocaine use, but its effects subside after treatment. Cognitive-behavioral therapy (CBT) produces reductions months after treatment. Combined, the 2 might be complementary. One hundred ninety-three cocaine-using methadone-maintained outpatients were randomly assigned to 12 weeks of group therapy (CBT or a control condition) and voucher availability (CM contingent on cocaine-negative urine or noncontingent). Follow-ups occurred 3, 6, and 12 months posttreatment. Primary outcome was cocaine-negative urine (urinalysis 3 times/week during treatment and once at each follow-up). During treatment, initial effects of CM were dampened by CBT. Posttreatment, there were signs of additive benefits, significant in 3- versus 12-month contrasts. Former CBT participants were also more likely to acknowledge cocaine use and its effects and to report employment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Levels of alcohol dependence in cocaine addicts: Some clinical implications.

Examined the severity of alcohol dependence in 268 primarily White male adult clients presenting themselves for residential treatment of cocaine addiction. Although previous research (e.g., M. Gold, 1984) has suggested that a majority of cocaine abusers also abuse alcohol, only a minority of these Ss (7%) could be classified in the substantial or severe categories of alcohol dependence. Results are discussed in light of previous findings (e.g., D. Smith; see record 1987-26330-001) which suggest that Ss in the low or moderate levels of alcohol dependence are most likely to reject abstinence-oriented treatment strategies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Demographic variables, smoking variables, and outcome across five studies.

Objective: Intervention effectiveness can potentially be affected by membership in different demographic subgroups (race, ethnicity, gender, age, and education level) or smoking behavior variables (time to first cigarette, longest previous quit attempt, number of attempts in the past year, number of cigarettes, and stage of change). Previous research on these 2 sets of variables has produced mixed results. Design: This secondary data analysis combined data from 5 effectiveness trials (a random-digit-dial sample [N = 1,358], members of an HMO [N = 207], parents of students recruited for a school-based study [N = 347], patients from an insurance provider list [N = 535], and employees [N = 175]) in which smokers were all proactively recruited from a defined population and all received the same expert system intervention. The intervention produced a consistent 22% to 26% point prevalence cessation rate across the 5 studies. Main Outcome Measures: The main outcome measures were 24-hr point prevalence, 7-day point prevalence, 30-day prolonged abstinence, and 6-month prolonged abstinence. Results: There were no significant differences in outcome across gender, race, and ethnicity subgroups. There were significant differences and small effect sizes for age and education subgroups. There were significant differences and large effect sizes for all 5 smoking behavior variables. Discussion: Demographic variables are static variables, whereas the smoking variables are more dynamic, that is, open to change. Given the dynamic nature of the smoking variables and the large effect sizes, interventions tailored on the smoking variables should be more successful. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mediators of telephone-based continuing care for alcohol and cocaine dependence.

A previous randomized trial with 224 alcohol and/or cocaine addicts who had completed an initial phase of treatment indicated that 12 weeks of telephone-based continuing care yielded higher abstinence rates over 24 months than did group counseling continuing care. The current study examined mediators of this treatment effect. Results suggested that self-help involvement during treatment and self-efficacy and commitment to abstinence 3 months after treatment mediated subsequent abstinence outcomes. These analyses controlled for substance use prior to the assessment of mediators. Conversely, there was no evidence that self-help beliefs or social support mediated the treatment effect. These results are consistent with a model in which treatment effects are first accounted for by changes in behavior, followed by changes in self-efficacy and in commitment to abstinence. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Vocher-based reinforcement of opiate plus cocaine abstinence in treatment-resistant methadone patients: Effects of reinforcer magnitude.

The study tested a voucher-based abstinence reinforcement procedure for reducing opiate and cocaine use in a population of treatment-resistant opiate- and cocaine-abusing methadone patients. Vouchers exchangeable for goods and services were contingent on abstinence from both opiates and cocaine. In two conditions, participants could earn up to $374 or $3,369 in vouchers for providing opiate- and cocaine-free urine samples. Participants received a daily 60-mg dose of methadone. The dose was increased in a second phase, and the voucher conditions were replicated. Analyses of both phases revealed trends toward greater abstinence under the high voucher condition and suggested that higher doses may enhance the efficacy of voucher reinforcement. The results show that reinforcement for abstinence from 2 drugs simultaneously can be effective even in a treatment-resistant population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictive factors for outcome of treatment for alcohol problems

Two samples of problem drinkers were followed up 2 and 4 years after they completed treatment. The first consisted of 72 men and 16 women admitted to a program for alcoholics (the inpatient sample), and the second, of 57 men and 35 women who participated in a program of outpatient treatment (the outpatient sample). At start of treatment, the outpatient sample, was generally characterized by a higher degree of social integration and more moderate alcohol problems than those found in the inpatient sample. These differences were sustained during the part of the follow-up period for which comparative data existed. In both samples it was possible to identify subgroups whose alcohol consumption throughout the observation period did not exceed average consumption in a comparative group of the Norwegian population. The most important predictive factors for alcohol consumption in the inpatient sample were degree of social integration, consumption before start of treatment, and sex. In the outpatient sample the most important factors were level of consumption and relative contribution of heavy drinking to the drinking pattern before start of treatment and the client's own goals as regards to alcohol. In both samples there was a close connection between alcohol consumed, total situation, and individual degree of satisfaction. For both groups, less frequent drinking and reduction of heavy drinking were most important for feeling satisfied with the drinking outcome. The therapeutic implications of the qualitative changes in drinking patterns are discussed.     

Coping with illness: Interrelationships across family members and predictors of psychological adjustment.

This study examined coping in families in which there was a chronically ill parent. Husbands, wives, and one child (aged 7–18 yrs) from 75 families in which the husband had hemophilia participated. Coping styles and psychological adjustment were assessed, and patterns of coping among family members were examined. Avoidant coping was associated with poorer adjustment for all family members. In addition, the coping style of one family member was found to be related to the psychological adjustment of other family members. Avoidant coping by one spouse related to poorer psychological functioning in the other spouse, and avoidant coping by either parent related to greater child adjustment problems for girls and boys. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Examination of predictors and moderators for self-help treatments of binge-eating disorder.

Predictors and moderators of outcomes were examined in 75 overweight patients with binge-eating disorder (BED) who participated in a randomized clinical trial of guided self-help treatments. Age variables, psychiatric and personality disorder comorbidity, and clinical characteristics were tested as predictors and moderators of treatment outcomes. Current age and age of BED onset did not predict outcomes. Key dimensional outcomes (binge frequency, eating psychopathology, and negative affect) were predominately predicted, but not moderated, by their respective pretreatment levels. Presence of personality disorders, particularly Cluster C, predicted both posttreatment negative affect and eating disorder psychopathology. Negative affect, but not major depressive disorder, predicted attrition, posttreatment negative affect, and eating disorder psychopathology. Despite the prognostic significance of these findings for dimensional outcomes, none of the variables tested were predictive of binge remission (i.e., a categorical outcome). No moderator effects were found. The present study found poorer prognosis for patients with negative affect and personality disorders, suggesting that treatment outcomes may be enhanced by attending to the cognitive and personality styles of these patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)