Predicting posttreatment cocaine abstinence for first-time admissions and treatment repeaters.
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OBJECTIVES: This study examined client and program characteristics that predict posttreatment cocaine abstinence among cocaine abusers with different treatment histories. METHODS: Cocaine abusers (n = 507) treated in 18 residential programs were interviewed at intake and 1-year follow-up as part of the nationwide Drug Abuse Treatment Outcome Study (DATOS). Program directors provided the program-level data in a mail survey. We applied the hierarchical linear modeling approach for the analysis. RESULTS: No prior treatment and longer retention in DATOS programs were positive predictors of posttreatment abstinence. The interactive effect of these 2 variables was also significantly positive. Program that offered legal services and included recovering staff increased their clients' likelihood of cocaine abstinence. Crack use at both the client and program level predicted negative impact. None of the program variables assessed differentially affected the outcomes of first-timers and repeaters. CONCLUSIONS: Although treatment repeaters were relatively difficult to treat, their likelihood of achieving abstinence was similar to that of first-timers if they were retained in treatment for a sufficient time. First-timers and repeaters responded similarly to the treatment program characteristics examined. The treatment and policy implications of these findings are discussed. (+info)
A comparison of presession and within-session reinforcement choice.
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Single- and concurrent-operants procedures were used to evaluate the effects of two reinforcement conditions on the free-operant responding of 3 individuals with developmental disabilities and 1 with attention deficit disorder. In the presession choice condition, prior to each session the participant chose one item from an array of three different highly preferred stimuli. This item was delivered by the experimenter on each reinforcer delivery during that session. In the within-session choice condition, each reinforcer delivery consisted of placing an array of three different highly preferred stimuli in front of the participant, who was allowed to select one. Only one of the two reinforcement conditions was in effect for any particular session in single-operant phases. Buttons associated with each reinforcement condition were present, and the participant could allocate responses to one or the other in concurrent-operants phases. Data showed substantially more responding to the button associated with within-session choice than presession choice during concurrent-operants phases. This effect was not as apparent during single-operant phases, suggesting that a concurrent-operants procedure provided the more sensitive evaluation of within-session and presession reinforcer choice effects. (+info)
Rapid recovery from cognitive deficits in abstinent alcoholics: a controlled test-retest study.
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The pattern of cognitive deficits and their time-dependent recovery were investigated in a cohort of 49 male alcohol-dependent patients using a repeated measurement design with 49 healthy male controls matched for age, education, and marital status. We combined parts of the Halstead Reitan Battery and the Wechsler Memory Scale with tests that are widely used in German-speaking countries. Patients were tested in the first week (T1) and 5 weeks later (T2) at the end of the in-patient treatment programme. Matched controls were tested also at T1 and T2, which enabled us to take learning effects into account. At T1, the patients showed distinct cognitive deficits on 5 of 12 neuropsychological parameters (perceptual-motor speed, verbal short-term memory, verbal knowledge, non-verbal reasoning, spatial imagination). At T2, significant improvements had occurred in four of the five dysfunctional domains with a significant difference remaining in verbal short-term memory. Duration of dependency and length of abstinence prior to testing had no essential effects on neuropsychological functions. Our results provide evidence for the well-established fact that chronic alcoholism has detrimental effects on cognitive performance, but that performance improves with neuropsychological recovery which occurs rapidly within weeks when abstinence is maintained. Cognitive deficits seem to be similar across different studies and cultures. (+info)
Surveillance of problem drug use in the UK: a review of a Regional Drug Misuse Database.
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BACKGROUND: We report detailed findings of the first systematic validation of a Regional Drug Misuse Database (RDMD); such databases constitute the main investment in routine drug statistics in the UK by the Department of Health. METHODS: A retrospective case-finding study in a stratified random sample of one in three specialist drug agencies was carried out. Agency records of clients attending during 1994 were matched with reports (episodes) to the North Thames RDMD to assess the level of under-reporting, and the relationship between RDMD reports (episodes) and the number of problem drug users in contact with agencies. Under-ascertainment of cases was estimated using two-sample capture-recapture. RESULTS: Under-reporting was associated with agency records missing full date of birth or initials (attributers), and agency type. Compared with drug dependency units (DDU) the odds of under-reporting were 3-18 times higher by the other specialist drug agencies. Even after excluding episodes with missing attributers the odds ratio (OR) of not being reported was significantly higher among needle exchanges (OR 2.7), non-statutory community based drug teams (OR 3.2), statutory community based drug teams (OR 4.9) and residential rehabilitation units (OR 8.7) compared with DDUs. Overall database episodes represented 60 per cent of the number of clients attending specialist agencies as a result of a mixture of under-reporting and the proportion of clients retained in treatment, which also varied by agency type. A total of 727 individuals (16 per cent) had never been reported. CONCLUSIONS: Surveillance of drug misuse through RDMDs does not yet fulfil its objectives. It is essential that a system of following up reports is introduced to improve their utility, and to contribute to the monitoring of the UK Government's new drugs strategy, and wider European surveillance. (+info)
Efficacy of lamotrigine in institutionalized, developmentally disabled patients with epilepsy: a retrospective evaluation.
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The paper evaluates the efficacy of the newer anticonvulsant lamotrigine in a developmentally disabled patient population. A retrospective evaluation was done at two institutional centres to assess adjunctive lamotrigine (Lamictal) efficacy in a developmentally disabled population. Mean seizure frequency was compared between a 2-month pre-lamotrigine baseline period and a 2-month treatment period. A 3-month lamotrigine titration phase occurred between baseline and treatment periods. Seizure frequency data was obtained from standardized, daily seizure records. Adverse effect data was obtained from medical and nursing notes. An intent to treat analysis was performed. Data were analysed using Student's t-test for paired data. We evaluated 44 centre residents (25 male, 19 female, average age 33 +/- 11 years). Mean lamotrigine dose was 272 +/- 133 mg per day. A significant reduction in seizure frequency was noted. Seizure frequency (all seizures) was 10.1 +/- 11.2 during the baseline period vs. 5.8 +/- 7.9 seizures per month during the treatment period (P = 0.002). Thirty-two percent of patients (n = 14) had greater than a 75% reduction in seizure frequency. Twenty-three percent of patients (n = 10) had a 50-74% seizure reduction. Twenty-five percent of patients (n = 11) had less than a 50% reduction in seizures, while 20% (n = 9) had an increase in seizures. A significant reduction of 48% in generalized seizures (9.5 +/- 11.6 vs. 4.9 +/- 6.5 seizures per month, P = 0.013) was noted. Reductions in partial seizure frequency of 48% (7.9 +/- 10 vs. 4 +/- 6.6 seizures per month, P = 0.16) as well as in mixed-type seizures (19.9 +/- 9.3 was vs. 15 +/- 12.1 seizures per month, P = 0.11) were also seen; however, these changes did not reach significance. Overall, lamotrigine was well tolerated by the subject population. Adjunctive treatment with lamotrigine appears to be an efficacious and well-tolerated treatment for seizures in a significant percentage of developmentally disabled patients with epilepsy. (+info)
Using positive peer reporting to improve the social interactions and acceptance of socially isolated adolescents in residential care: a systematic replication.
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We studied how rewarding youth in residential care for publicly reporting positive social behavior influenced the social interactions and acceptance of their most socially isolated peers. Results showed that the intervention resulted in substantial improvements in social interactions by the previously isolated peers. Peer acceptance ratings also improved for 2 of the target youths. (+info)
Independent use of activity materials by the elderly in a residential setting.
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A lottery was implemented to encourage the elderly clients of a residential home to use activity materials any time they wished, independently of staff intervention and the institutional routine of the home. During baseline, there were minimal levels of independent use of activity materials by residents. Various conditions were implemented but only the introduction of a l20 lottery prize brought about a significant increase in the frequency of independent use of activity materials. A follow-up suggested that the reinforcing properties of the activity materials themselves eventually maintained the target behavior. (+info)
Outcome after in-patient detoxification for alcohol dependence: a naturalistic comparison of 7 versus 28 days stay.
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Research has tended to show that the gains of residential rehabilitation are short-term and cost-inefficient. This study compares the outcomes of two samples, one group staying at a non-statutory sector alcohol detoxification unit for < or =7 days (short stay: SS) with a second group also admitted for detoxification but who stayed at the Unit for a further 8-21 days (long stay: LS). Allocation was not at random: the longer stay was either at the request of the client, referring or treatment agency itself and then had to be approved by an external funding agency. Sixty-four DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) alcohol-dependent subjects were studied. Baseline data included socio-demographic information, illicit drug use during the past 12 months, severity of alcohol dependence, alcohol problems, physical/psychological symptoms, depression and indices of quality of life. At baseline, LS subjects reported more recreational cannabis use than SS subjects. Sixty-two (97%) subjects were re-interviewed 12 weeks after baseline assessment. During follow-up, equal proportions of each group relapsed (> or =21 units/7 day period fo males; > or =14 units/7day period for females). There was a trend for SS clients to have consumed less alcohol in total than the LS clients. The trend was towards improvement in the study measurements for the SS group, though none of the changes was significant. In the LS group, all variables tended towards a deterioration in health status. The longer stay did not appear to confer any extra benefit to the LS group. Cannabis use and illicit drug use at baseline, while commoner in the LS group, did not predict drinking or social adjustment in the follow-up period in this sample and thus could not be used to explain the lack of a better outcome in the LS group. (+info)