Treatment settings for persons with alcoholism: Evidence for matching clients to inpatient versus outpatient care.

This study compared inpatient, intensive outpatient, and standard outpatient treatment settings for persons with alcoholism and tested a priori hypotheses about the interaction of setting with client alcohol involvement and social network support for drinking. Participants (N?=?192) were assigned randomly in cohorts to 1 of the 3 settings. The settings did not differ in posttreatment primary drinking outcomes, although inpatients had significantly fewer jail and residential treatment days combined than outpatients. Clients high in alcohol involvement benefited more from inpatient than outpatient care; the opposite was true at low alcohol involvement levels. Network drinking support did not moderate setting effects. Clients low in cognitive functioning also appeared to benefit more from inpatient than outpatient care. Improved outcomes might be achieved by matching degree of alcohol involvement and cognitive functioning to level of care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative effectiveness of day hospital and inpatient psychiatric treatment.

Employed a pre–posttreatment control group design to compare the treatment effects of partial hospitalization to those of full-time hospitalization. Ratings of home and community adjustment were obtained from community informants (relatives or close friends) for 2 groups of Ss: (a) 24 day-hospital clients (partial hospitalization condition) matched on age (average age 32 yrs), education, and intelligence with (b) 24 inpatient clients (full-time hospitalization condition), and from an unmatched sample of 79 consecutive inpatient admissions. Treatment outcome was measured by clients' pre- and postscores on the Personal Adjustment and Role Skills scale. Results show that all groups evidenced improvement 2 mo after treatment started, particularly on measures of symptom reduction. Although patterns of improvement were comparable for both settings in univariate data analyses, multiple discriminant function analysis indicated that the day hospital sample evidenced greater gains in attentiveness and in employment. Gains favoring the day hospital sample were more striking for the unmatched 3-group comparison than for the matched 2-group comparison. Findings indicate that partial hospitalization is an attractive alternative to inpatient psychiatric hospitalization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in alcoholic patients' coping responses predict 12-month treatment outcomes.

Patient subtypes (Types A and B alcoholism), determinants, and outcomes associated with changes in coping responses of 133 alcoholic patients in the year following admission to treatment were examined. In general, patients' use of avoidance coping declined and use of approach coping increased. Type B patients used more avoidance coping than did Type A patients, but the subtypes did not differ in rate of change in coping. As a determinant of coping, cognitive appraisal of threat showed a trend toward predicting avoidance coping at 6- and 12-month follow-ups. Decreased cognitive avoidance coping (e.g., daydreaming) predicted fewer alcohol, psychological, and interpersonal problems. Increased behavioral approach coping (e.g., taking action) predicted lower severity of alcohol problems. Further study of changes in the cognitive aspects of coping (i.e., appraisals and cognitive avoidance coping) is needed to determine mechanisms underlying cognitive processes associated with treatment outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Preparing clients for alcoholism treatment: Effects on treatment participation and outcomes.

In this study, 126 clients (87 men, 39 women) entering outpatient alcoholism treatment were assigned randomly to 1 of 3 preparatory conditions: a role induction (RI) session, a motivational interview (MI) session, or a no-preparatory session control group (CG). Clients assigned to the MI preparatory condition attended more treatment sessions and had fewer heavy drinking days during and 12 months after treatment relative to CG clients. Clients assigned to MI, relative to CG clients, also had more abstinent days during treatment and during the first 3 months posttreatment, although this difference was not maintained through the remainder of the 12-month follow-up period. Clients assigned to the RI condition showed no significant advantage over those in the CG condition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists in public inpatient psychiatric settings: Ethical dilemmas.

Psychologists face new ethical dilemmas as their roles expand in public hospital psychiatric units. Clinical and administrative practices indicate psychological values, models, and interventions are useful and effective when serving seriously mentally ill inpatients. Issues addressing the clinical, administrative, and training competence of psychologists in public hospital settings are discussed. It is recommended that national guidelines be developed to be used by state licensing and hospital credentialing boards in verifying preparation for public inpatient psychiatric practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An analysis of the nature and justification of treatment decisions in inpatient settings.

83 mental health professionals employed at 2 inpatient settings participated in a study on the nature and justification of assessment and treatment decision making. Clinical psychologists, psychiatrists, a psychiatric nursing service staff group, social workers, nonpsychiatric physicians, physician assistants, mental health workers/psychiatric technicians who had at least a high school diploma, rehabilitation specialists, and psychiatric administrators completed a treatment decision questionnaire. It addressed several specific content areas relating to the types of assessment procedures, treatment goals, and treatment methods mental health professionals usually use, as well as the usual reason(s) for such procedures. Results showed that inpatient mental health professionals mostly relied on past success as well as logistical-practical factors in the determination and justification of assessment and treatment methods. Analyses of differences among inpatient institutions and mental health professionals are also presented. The conclusion was that, regardless of the specific assessment and treatment methods relied on, mental health professionals did use systematic decision procedures in choosing such methods. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychophysiological treatment of migraine and tension headaches: A 12-month follow-up.

Conducted a 12-mo follow-up of the present authors' (1983) study population of chronic headache sufferers by telephone interviewing 31 chronic migraine and 25 chronic tension headache patients (aged 18–61 yrs) who had been treated with EMG, muscle relaxation, and fingertip temperature training to test a hypothesis of biofeedback placebo effects. A previous 3-mo follow-up had revealed that all treatments had produced significant improvement, and relaxation was not as good as the biofeedback devices for obtaining a reduction in monthly headache hours. At 12-mo follow-up, the 3-mo improvement was sustained overall, but migraineurs as a group appeared to regress slightly, while tension patients improved significantly in the interim. On the basis of a 50% reduction in symptomatology, biofeedback treatment was significantly superior to relaxation for tension headaches, although this had not been true at the 3-mo assessment. Temperature training was at least as effective as EMG for both headache groups. In view of these results, biofeedback treatment is viewed less as placebo administration and more as a secondary reinforcer of a specific but unknown physiological response. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Theoretical and practical foundations of an inpatient post-traumatic stress disorder and alcoholism treatment program.

Describes the structure and process of an inpatient program for the treatment of posttraumatic stress disorder (PTSD) and alcoholism. The therapeutic community setting uses lifespan developmental and social learning models to provide patients with (1) a framework for understanding what has happened to them, (2) tools for more effective coping, (3) an arena to experience the discomfort of previous coping mechanisms, and (4) the anxiety/pleasure of creating and practicing a new and more effective repertoire of skills. The program is divided into 3 phases. Phase 1 focuses on solidifying motivation for change through assessment, education, and interpersonal work. Phase 2 represents the action stage, and incorporates exposure-based therapy in a developmental framework to address trauma issues. Phase 3 emphasizes maintenance and generalization of patients' learning via modified relapse prevention training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assertions regarding effectiveness of treatment for alcoholism: Fact or fantasy?

Treatment of alcoholism and public policy decisions are likely to be misguided when based on the uncritical adoption of treatment-effectiveness claims. Thoughtful consideration of any assertion of effectiveness of treatment of alcoholism rests on an understanding of external and internal validity issues as well as the issue of comprehensiveness of evaluation. Treatment-outcome figures are influenced by such external validity factors as patient characteristics, sample selection and attrition, patient experiences outside of and after treatment, time of evaluation in relation to treatment, type and definition of criterion variables, measurement of criterion variables, and the analysis and interpretation of data. Among the internal validity factors affecting outcome rates are investigator bias, demand characteristics, and efforts to compare patient self-report data with other sources of information. A comprehensive assessment of treatment effectiveness requires the use of multiple-outcome criterion measures such as treatment completion, recidivism, physical health, and social and emotional functioning as well as evaluation of drinking behavior. (75 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized trial comparing day and residential drug abuse treatment: 18-month outcomes.

Extending an earlier report of 6-month outcomes, this study reports 12- and 18-month follow-up data for clients (N?=?188) entering a therapeutic community drug treatment program who were randomly assigned to day or residential treatment conditions. Outcomes included Addiction Severity Index composite scores and measures of depression, psychiatric symptoms, and social support. Both groups showed significant change over time. The pattern of change indicated decreased problem severity in the 1st 6 months and then maintenance of lowered problem severity. Comparisons between groups indicated greater improvement for residential treatment clients on social problems and psychiatric symptoms but no differences on the remaining outcomes. Although residential treatment may offer some specific advantages, the conclusion here is that improvement among day treatment clients was not significantly different from that of residential treatment clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Youth psychotherapy change trajectories and outcomes in usual care: Community mental health versus managed care settings.

Objective: The authors compared symptom change trajectories and treatment outcome categories in children and adolescents receiving routine outpatient mental health services in a public community mental health system and a private managed care organization. Method: Archival longitudinal outcome data from parents completing the Youth Outcome Questionnaire (Y-OQ) were retrieved for children and adolescents (4–17 years old) served in a community mental health system (n = 936, mean age = 12 years, 40% girls or young women, 28% from families of color) and a managed care organization (n = 3,075, mean age = 13 years, 45% girls or young women, race and ethnicity not reported). The authors analyzed Y-OQ data using multilevel modeling and partial proportional odds modeling to test for differences in change trajectories and final outcomes across the 2 service settings. Results: Although initial symptom level was comparable across the 2 settings, the rate of change was significantly steeper for cases in the managed care setting. In addition, 24% of cases in the community mental health setting demonstrated a significant increase in symptoms over the course of treatment, compared with 14% of cases in the managed care setting. Conclusions: These results emphasize the need for increased attention to negative outcomes in routine mental health services and provide a stronger foundation for identifying youth cases at risk for treatment failure. In addition, given the overall differences observed across treatment settings for average rate of change and deterioration rates, results suggest that setting-specific model heuristics should be used for identifying cases at risk for negative outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Day treatment with contingency management for cocaine abuse in homeless persons: 12-month follow-up.

Abstinence, employment, and homelessness treatment outcomes at 12-month follow-up are presented from a study comparing behavioral day treatment plus abstinence-contingent housing and work therapy with behavioral day treatment only among homeless persons who abuse crack cocaine. Within-group improvements were revealed, but group differences for drug abstinence found in J. B. Milby et al. (2000) failed to persist at 12 months. Drug use measurement and treatment termination explanations are discussed. Within- but not between-group differences were found for employment and homelessness outcomes at long-term follow-up. Research extending abstinence contingencies and continuous drug use monitoring is recommended. Questions about effectiveness of contingency management alone, role of coexisting psychiatric disorders on treatment outcome, and individualized treatment dosing are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

The practice of psychology in hospital settings.

Psychologists are taking the lead to ensure that consumers have full access to behavioral science knowledge in America's hospitals. This article recaps the development of psychology's position in hospitals and explores the variety of current and prospective roles of psychologists in inpatient health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term effects of behavior therapy: A 12-month follow-up.

19 female undergraduates who underwent various behavioral treatments designed to reduce a specific fear were paid to return for follow-up 1 yr. later. In general, treated Ss' rat fears were less intense 1 yr. after treatment than they had been prior to treatment, with those treated by systematic desensitization slightly less fearful than those treated with "rational therapy." Subsequently, the desensitized Ss eliminated a snake fear by themselves, but the effects of this self-administered desensitization were not maintained. Additionally, 6 children treated by operant conditioning techniques for various problems were reevaluated 1 yr. later. All behavior change was maintained, but only those who had graduated to social reinforcement showed additional improvement. No evidence for symptom substitution was obtained from either group of Ss. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ropinirole for the treatment of early Parkinson disease: a 12-month experience. Ropinirole Study Group

OBJECTIVE: To evaluate ropinirole hydrochloride as dopaminergic monotherapy in patients with early Parkinson disease. DESIGN: A 6-month extension of a double-blind, placebo-controlled study. SETTING: Ambulatory care at 22 different sites in the United States. PATIENTS: Patients who successfully completed the initial 6-month study could enter the 6-month extension study (ropinirole, n = 70; placebo, n = 77). INTERVENTION: Use of ropinirole or placebo therapy. MAIN OUTCOME MEASURES: The efficacy variables were the number of patients who successfully completed the 12-month study and did not require supplemental levodopa, the number of patients requiring supplemental levodopa, and the proportion of patients having an insufficient therapeutic response. RESULTS: Significantly fewer ropinirole-treated patients met criteria for insufficient therapeutic response (23 [19.8%] of 116) or required the initiation of levodopa therapy (22 [19%] of 116) compared with placebo-treated patients (60 [48%] of 125 patients for insufficient therapeutic response; 57 [45.6%] of 125 patients for additional levodopa). Significantly more ropinirole-treated patients (51 [44.0%] of 116) successfully completed the 12-month study and did not require supplemental levodopa compared with placebo-treated patients (28 [22.4%] of 125). The incidence of adverse experiences and patient withdrawals was low. CONCLUSION: Ropinirole was effective and well tolerated as monotherapy for 12 months in patients with early Parkinson disease.     

Clinical psychology in general hospital settings: Issues in interprofessional relationships.

We suggest that the involvement of clinical psychologists in health care teams may not necessarily improve health care. The position of clinical psychology with regard to medical theory and practice is examined. Then issues arising from multidisciplinary teamwork, with particular emphasis on consultation–liaison work, are discussed. We conclude that professional power structures in hospital settings have a profound influence on clinical psychological practice and that these issues need to be explicitly addressed before health care can benefit from the expertise of clinical psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of random versus nonrandom assignment in a comparison of inpatient and day hospital rehabilitation for male alcoholics.

Alcoholic patients randomly assigned to day hospital or inpatient rehabilitation were compared with patients who self-selected these treatment settings to examine differences in substance use and psychosocial outcomes under experimental and nonexperimental designs. Patients who self-selected treatment did not have better outcomes than those who were randomly assigned, and there were no significant differences between day hospital patients and inpatients on any of the 11 outcome measures. Significant interactions between treatment setting and assignment were found with only 2 outcome measures. Therefore, the comparisons between day hospital and inpatient treatment yielded similar outcomes under both "scientific" conditions and the conditions that more closely approximate the experiences of most patients. Implications for the use of nonrandomized participants in alcoholism treatment research and limitations of the study were also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder treatment in correctional settings: A brief review of the empirical literature and suggestions for future research.

This article reviews the available empirical studies of posttraumatic stress disorder (PTSD) treatments for correctional populations. Despite the large numbers of prisoners and their high rates of victimization and traumatic disorders, few targeted treatments are available, and even fewer have been studied and empirically supported. The treatment modalities that have been studied include two exposure, two cognitive, and two skills-based approaches investigated in a total of eight studies. Four studies that met criteria for this review were conducted with women, three with juvenile males, and one with a single man. The studies possess many methodological weaknesses, and some outcomes have been disappointing. In the hopes of preventing further suffering, revictimization, and recidivism, it is imperative that further development and investigation of targeted treatments continue in this understudied and vulnerable population. Much progress has been made in the treatment of PTSD in the general population, so these approaches could be explored in the correctional system as well. (PsycINFO Database Record (c) 2010 APA, all rights reserved)