Locus of control and patient attrition from an alcoholism treatment program.

Investigated the relationship of male alcoholics' locus of control scores to dropping out of treatment at various stages. No differences were found among Ss who left at 2 wks, dropped out between 2 wks and 60 days, or completed the 60 dys, or among patients who completed or left the 1-yr aftercare program in total, personal, sociopolitical control scores. Ss who dropped out of aftercare had significantly lower total and personal control scores, and a significantly greater change in personal control in the internal direction, at the end of the intensive treatment than those who completed the aftercare, contrary to prediction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment outcome for impoverished alcoholics in an abstinence-based program

Positive patient characteristics have been assumed important in determining treatment outcome for the abstinence-based method of addiction treatment. Thus far, controlled and uncontrolled studies of the abstinence-based method have examined predominantly employed, White, and married populations of alcoholics. We present a treatment outcome study of the abstinence-based method of treatment in unemployed, Black, and unmarried population of alcoholics. The negative patient characteristics of our study did not predict an unfavorable outcome in comparison to those in other studies that included positive patient characteristics.     

An integrated medical and psychosocial treatment program for psychotic disorders: patient characteristics and outcome

OBJECTIVES: To provide an overview of a comprehensive and integrated case-management program that incorporates principles of assertive community treatment and combines effective medical and psychosocial interventions and to present the results of a process and outcome evaluation of the program, with particular emphasis on its impact on service utilization and consumer satisfaction. METHOD: Data on demographic, clinical, and several outcome measures were collected on all patients who received care in the program for a minimum of 6 months. For process evaluation we assessed the extent to which the program adhered to its goals and satisfied the patients, their families, and community-service agencies. Outcome-evaluation data on the number and length of hospital admissions were compared for each subject with individual historical data for a period equal to the time spent in the program. In addition, relapses of psychotic symptoms that did not result in hospital admissions were calculated for each patient while in the program. RESULTS: Demographic, clinical, and treatment characteristics of clients show that the program has succeeded in maintaining its focus on providing services to relatively chronically ill patients with psychotic disorders over a mean period of 3 years. The process-evaluation data indicated a high level of satisfaction by patients, families, and other service agencies with the services received. Information on outcome variable showed that the program achieved significantly lower rates of hospital admissions and relapse of psychosis than expected. There was a highly significant reduction achieved in the utilization of inpatient hospital resources for patients receiving care in the program. Most of the inpatient service utilization was attributed to patients either who were resistant to treatment with antipsychotic agents or who refused to accept or comply with medication. CONCLUSIONS: It is possible to provide effective continuity of care from inpatient treatment to community adjustment for most individuals with psychotic disorders across the spectrum by blending hospital and community resources within an integrated case-management model of care.     

Patient characteristics and outcome in psychotherapy and behavior therapy.

94 psychoneurotic or personality disordered patients received 4 mo of analytically oriented psychotherapy, behavior therapy, or waiting list treatment. The demographic variables included age (early twenties), sex (60% female), marital status (26% married), number of siblings (2), and birth order. Neither active treatment was more effective than the other with any type of symptom (including affective ones), although both were more consistently effective than the waiting list. With psychotherapy, relatively greater success was associated with less overall pathology on the MMPI and higher socioeconomic status. Psychotherapy was least effective with Ss who scored high on the Hysteria and Psychopathic Deviate scales. There was also a strong but nonsignificant trend for more improvement in psychotherapy Ss who were younger, female, married, later born, more intelligent, and from smaller families. Behavior therapy was more effective with those who scored high on the Hysteria and Mania scales and seemed to be effective with a broader range of patients. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Computerized smoking cessation program for the worksite: Treatment outcome and feasibility.

This study demonstrated the effectiveness of a computer-delivered smoking cessation program for the worksite. 58 VA Medical Center employees were randomly assigned to a computer group (computerized nicotine fading and stop-smoking contest) or a contest-only group. In comparison with the contest-only group, the computer group had nonsignificantly higher abstinence rates across follow-up, had marginally lower CO levels at the 3- and 6-month follow-ups, and smoked cigarettes with lower nicotine levels at the 10-day and 6-month follow-ups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conditioned flavor aversions to familiar tap water in rats: An adjustment with implications for aversion therapy treatment of alcoholism and obesity.

Notes that conditioned flavor aversions, readily established in rats by pairing a novel palatable flavor with radiation-induced or drug-induced illness, are highly efficient adjustments with implications for the treatment of alcoholism and obesity. Recent experiments show that such aversion acquisition is diminished by preconditioning familiarity with the conditioned stimulus (CS) flavor. However, these studies involved single pairings of the target flavor with postingestional illness. In the present experiment with Sprague-Dawley-derived male rats, multiple conditioning trials and discrimination training were combined to produce a marked aversion to a highly familiar and relatively bland substance, plain tap water. This conditioned water aversion demonstrates the transient nature of the CS familiarity effect, thus weakening any contention that preconditioning exposure to target flavors will necessarily render aversion therapy for alcoholism or obesity ineffective. (39 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)     

Patient-therapist identification in relation to both patient and therapist variables and therapy outcome.

18 patients in a counseling center completed (a) a battery of tests, including scales from the MMPI and Gibson's Acceptance of Self; and (b) rating scales measuring S's identification with and perception of the therapist. Results reveal that S's identification with the therapist significantly correlated with therapy improvement. Degree of identification was associated with both (a) subjective feelings of helplessness and weakness and (b) perception of a stronger therapist during therapy. S's perception of the therapist's strength was incongruent with external judges' ratings of therapist competence, indicating that S's ratings were based on subjective needs. (28 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns of services and consumer outcome in an intensive case management program.

This study examined the patterns of services provided to individuals with serious and persistent mental illness during their first year in an intensive case management program. Services in 10 content areas were examined, and patterns for more versus less "successful" individuals were compared. Differences emerged for services focusing on family and housing, suggesting that the need for community support services influences the need for continued intensive case management. Linear reductions in rehabilitation services suggest that such services may indeed be effective early in the treatment process. Finally, differences among case managers in service patterns for 5 of the 10 content areas suggest that case managers play an important role in determining the course of treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group cognitive-behavioral therapy for generalized anxiety disorder: Treatment outcome and long-term follow-up.

A recently developed cognitive-behavioral treatment for generalized anxiety disorder (GAD) targets intolerance of uncertainty by the reevaluation of positive beliefs about worry, problem-solving training, and cognitive exposure. As previous studies have established the treatment's efficacy when delivered individually, the present study tests the treatment in a group format as a way to enhance its cost-benefit ratio. A total of 52 GAD patients received 14 sessions of cognitive-behavioral therapy in small groups of 4 to 6 participants. A wait-list control design was used, and standardized clinician ratings and self-report questionnaires assessed GAD symptoms, intolerance of uncertainty, anxiety, depression, and social adjustment. Results show that the treatment group, relative to the wait-list group, had greater posttest improvement on all dependent variables and that treated participants made further gains over the 2-year follow-up phase of the study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Severity of psychosocial stress and outcome of alcoholism treatment.

Examined the relation between stressful life events and drinking outcome among 129 male alcoholics (aged 22–70 yrs) who had completed an alcohol treatment program. Life events were assessed for the year prior to treatment and for the 3 mo after treatment and were rated on a modified version of the Psychiatric Epidemiology Research Interview and the Contextual Rating System (G. W. Brown and T. O. Harris, 1982). Approximately 40% of the pretreatment stressors were found to be directly or indirectly related to alcohol use. When stressors related to drinking were excluded from consideration, men who returned to drinking after treatment were found to experience more severe or highly threatening stress before their relapse than men who remained abstinent during the follow-up period. These data suggest that although less severe stress may not increase risk for relapse, acute severe stressors and highly threatening chronic difficulties may be associated with elevated relapse risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of therapist adherence and competence on patient outcome in brief dynamic therapy.

The authors examined the relation between therapist process variables (adherence and competence) and subsequent symptomatic change in patients. 29 depressed patients were seen in 16 sessions of weekly supportive expressive (SE) dynamic psychotherapy. Change in depression from intake to Session 3 predicted higher ratings of adherence to expressive (interpretative) techniques during Session 3 but not their competent delivery. Partialling pretreatment psychiatric severity, therapists' adherence to use of expressive techniques, and previous symptomatic improvement, relatively competent delivery of SE-specific expressive techniques predicted subsequent improvement in depression, Secondary analyses addressing alternative explanations (such as the role of either therapeutic alliance or general therapeutic skills) did not change the results. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trauma patient outcome after the Prehospital Trauma Life Support program

BACKGROUND: We have previously demonstrated a significant improvement in trauma patient outcome after the Advanced Trauma Life Support (ATLS) program in Trinidad and Tobago. In January of 1992, a Prehospital Trauma Life Support (PHTLS) program was also instituted. This study assessed trauma patient outcome after the PHTLS program. METHODS: Morbidity (length of stay and degree of disability), mortality, injury severity score, mechanism of injury, age, and sex among all adult trauma patients transported by ambulance to the major trauma hospital were assessed between July of 1990 to December of 1991 (pre-PHTLS, n = 332) and January of 1994 to June of 1995 (post-PHTLS, n = 350). RESULTS: Age, sex distribution, percentage blunt injury, and injury severity score were similar for both groups. Mortality pre-PHTLS (15.7%) was greater than post-PHTLS (10.6%). Length of stay and disability were statistically significantly decreased post-PHTLS. Age, injury severity score, and mechanism of injury were positively correlated with mortality in both periods. The previously reported post-ATLS mortality was similar to the pre-PHTLS mortality. CONCLUSIONS: Post-PHTLS mortality and morbidity were significantly decreased, suggesting a positive impact of the PHTLS program on trauma patient outcome.     

Predicting successful completion of an aftercare program following treatment for alcoholism: The role of dispositional optimism.

In this study we investigated several variables as potential predictors of success in completing a transition program after treatment for alcoholism. Subjects were 54 men who had completed a 30-day treatment program and who were subsequently admitted to a 90-day inpatient aftercare program. The outcome measure was successful completion of this latter program. Predictor variables were dispositional optimism, hassles, uplifts, and several demographic variables. Optimism was positively associated with successful outcome. The simple association between uplifts and outcome also approached significance, but in the opposite to expected direction. Discriminant analyses used both of these variables, as well as age and education level, as predictors of successful outcome. There was no evidence of a role for hassles. Discussion centers on the importance of dispositional optimism as a predictor of successful adaptation in a variety of behavioral domains. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment adherence, competence, and outcome in individual and family therapy for adolescent behavior problems.

This study examined the impact of treatment adherence and therapist competence on treatment outcome in a controlled trial of individual cognitive-behavioral therapy (CBT) and multidimensional family therapy (MDFT) for adolescent substance use and related behavior problems. Participants included 136 adolescents (62 CBT, 74 MDFT) assessed at intake, discharge, and 6-month follow-up. Observational ratings of adherence and competence were collected on early and later phases of treatment (192 CBT sessions, 245 MDFT sessions) by using a contextual measure of treatment fidelity. Adherence and competence effects were tested after controlling for therapeutic alliance. In CBT only, stronger adherence predicted greater declines in drug use (linear effect). In CBT and MDFT, (a) stronger adherence predicted greater reductions in externalizing behaviors (linear effect) and (b) intermediate levels of adherence predicted the largest declines in internalizing behaviors, with high and low adherence predicting smaller improvements (curvilinear effect). Therapist competence did not predict outcome and did not moderate adherence-outcome relations; however, competence findings are tentative due to relatively low interrater reliability for the competence ratings. Clinical and research implications for attending to both linear and curvilinear adherence effects in manualized treatments for behavior disorders are discussed. (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)     

Blood nicotine and carboxyhemoglobin levels after rapid-smoking aversion therapy.

Studied blood nicotine and carboxyhemoglobin (COHb) levels after rapid smoking in 5 male and 10 female smokers. Male Ss were under 40 yrs of age and females were under 50. Blood nicotine averaged 48.1 ng/mg after rapid smoking compared to 32.4 ng/ml after normal smoking, and COHb levels averaged 12.1% and 8.9%, respectively. Both differences were significant. Normal smoking levels of 92 smokers in other studies averaged around 30 ng/ml nicotine and 8.2–8.5% COHb. There was no evidence that the degree of nicotine and carbon monoxide intoxication produced during raid smoking had any relation to the reduction in the desire to smoke immediately after the session or the decrese in cigarette consumption on the following day. The potential risks of rapid smoking are discussed. It is suggested that these risks might be reduced by using a beta-adrenergic blocker and that the procedure could be made completely safe, possibly without loss of treatment effect, if Ss were instructed not to inhale. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of motivational interviewing on participation and outcome in residential alcoholism treatment.

Tested motivational interviewing (a strategy to increase motivation for change) as a preparation for residential alcoholism treatment. 28 consecutive alcoholism admissions to a psychiatric hospital were assigned alternately to receive or not to receive a 2-session motivational assessment and interview shortly after intake, in addition to standard evaluation and treatment procedures. Patients who received the motivational interview participated more fully in treatment (as evidenced by therapist ratings) and showed significantly lower alcohol consumption at a 3-mo follow-up interview. The beneficial effects of motivational interviewing on outcome were mediated by increased participation in treatment. The extent to which the received treatment outcome conformed to patients' pretreatment expectations was predictive of outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)