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Presents a study designed to assess the impact of cocaine abuse on a general psychiatric service and an obstetrics service in an urban general hospital and to evaluate a program for engaging affected patients in addiction treatment. Method ; Results; Conclusions.

Individual therapists in office practice are often considered to have limited effectiveness in treating alcohol and drug dependence. In this article the author describes network therapy, an approach developed to assure greater success in such treatment. It uses psychodynamic and behavioral therapy while engaging the patient in a support network composed of family members and peers. A cognitive-behavioral model of addiction, based on the role of conditioned withdrawal in relapse, is described. Related techniques for securing abstinence are then reviewed; they augment individual psychotherapy to help patients avoid relapse caused by the affective and environmental cues that precipitate drug seeking. The role of social cohesiveness as a vehicle for engaging patients in treatment is outlined next, along with a related technique for enhancing an addicted patient's commitment to the therapy. This is done by using the patient's family and peers as a therapeutic network to join the patient at intervals in therapy sessions. The network is managed by the therapist to provide cohesiveness and support, undermine denial, and promote compliance with treatment. The author presents applications of the network technique designed to sustain abstinence and describes means of stabilizing members' involvement. Applications of network therapy to ambulatory detoxification, disulfiram and naltrexone administration, relapse prevention, and contingency contracting are reviewed.

Objective: The authors surveyed psychiatrists in the Christian Psychiatry movement to assess the role of religious belief in their practices., Method: The psychiatrists were members of the Christian Medical and Dental Society; questionnaires were sent to 260, and usable responses were received from 193. The subjects were asked about demographic and practice variables, "born again" religious experiences, group cohesion, and beliefs about using the Bible and prayer in treatment., Results: The respondents were somewhat more religious than Americans overall, who are themselves more religious than most psychiatrists. Nearly all reported having been "born again," after which they generally experienced a decrease in emotional distress. There was a significant difference in the respondents' affiliative feelings toward psychiatrists in the Christian Psychiatry movement and other psychiatrists. For acute schizophrenic or manic episodes, the respondents considered psychotropic medication the most effective treatment, but they rated the Bible and prayer more highly for suicidal intent, grief reaction, sociopathy, and alcoholism. Whether or not a patient was "committed to Christian beliefs" made a significant difference in whether the respondents would recommend prayer to the patient as treatment. About one-half said they would discourage strongly religious patients from an abortion, homosexual acts, or premarital sex, and about one-third said they would discourage other patients from these activities., Conclusions: Many studies have suggested a need for more sensitivity to religious issues by psychiatrists, and this study provides systematic findings on one approach. It remains important to evaluate ways in which a religious perspective can be related to clinical practice and what benefits and problems may derive from such a relationship.

The authors studied 40 cocaine-dependent subjects admitted to psychiatric inpatient wards of a metropolitan hospital because of general psychiatric symptoms. The results indicate that the predominant form of cocaine administration (88%) was freebasing "crack." DSM-III-R cluster B personality disorders (N = 17) and schizophrenia (N = 13) constituted the diagnoses for 75% of the sample. Compared to the schizophrenic patients in this cohort, the patients with cluster B personality disorders used cocaine in greater quantities and more frequently and began abuse of the drug at an earlier age. The escalation in urban areas of psychiatric hospitalizations attributed to use of crack may be largely related to psychiatric symptoms in cocaine-dependent patients with personality disorders as well as cocaine-induced psychopathology in schizophrenic patients.

Modern cults and zealous self-help movements exercise an intense group influence and can have a major impact on their members' psychiatric status. On the basis of research findings, the author describes the charismatic group, a generic model for such cohesive, intensely ideological movements. He examines the psychological forces they tap and the way they can both relieve and exacerbate psychopathology. The model is then used to explain the operation of zealous self-help programs that address psychiatric syndromes; these are directed at problems of the medically ill, substance abusers, and relatives of psychiatric patients.

The authors studied 100 impaired physicians who were successfully treated in a program that combined professionally directed psychotherapeutic treatment and peer-led self-help. An average of 33.4 months after admission they all reported being abstinent and rated Alcoholics Anonymous (AA) as more important to their recovery than professionally directed modalities. Feelings of affiliativeness to AA, which were very high, were strong predictors of the respondents' perceived support for their recovery. These feelings, and an identification with the role of care giver in addiction treatment, appeared to be central to their recovery process.

The author studied the psychological aspects of religious conversion during structured 21-day workshop sequences designed to introduce people to the Unification Church. Subjects were given a battery of tests at different times during the sequence. After the initial 2-day workshop, 71% dropped out; the 29% who chose to continue had greater affiliative feelings toward the group and greater acceptance of the church's creed than these early dropouts. The 9% who ultimately joined the church had weaker outside personal ties than the later dropouts, although their beliefs in and cohesiveness toward the church were the same as the late dropouts. These results are also compared with long-standing members of the church and matched nonmembers. The induction procedures used by the church are discussed with regard to those used by large therapeutic groups, such as self-help organizations.

The author describes a model of intoxicant use based on altered states of consciousness and reviews his own and others' research on marijuana to illustrate the utility of this model, which is derived from both introspective reports and observed data. The relationship of social behavior and cognitive functioning to the "intoxication state of consciousness" is discussed. This state of consciousness may have an adaptive value in engendering and stabilizing social cohesion. Possible treatment implications include cognitive labeling of cues that precipitate episodes of abuse, training for moderated drug use while patients are intoxicated, and providing abusers with altered consciousness through other means, such as meditation.

The authors undertook this study to enhance psychiatric understanding of contemporary charismatic religious sects. After a pilot study, a representative sample of members of the Unification Church (N = 237) completed a 216-item structured questionnaire. Respondents were below the mean for an age- and sex-matched group on a psychological general well-being scale, and they reported significantly greater neurotic distress before conversion. The authors discuss correlates of an improved emotional state following conversion and employ attribution theory, drawn from social psychology, to put the conversion process into a psychiatric perspective.

A national movement of parent self-help groups has recently emerged to combat drug abuse in children and adolescents. This innovative modality addresses a major mental health problem in an area where manpower shortages are anticipated. On the basis of self-report data from 135 parent group members, the drug and behavior problems of their children were evaluated. Improvement was reported in the community at large but more frequently in the children of members. The parent groups differed notably in structure and activities; nonetheless, the underlying psychology of membership, i.e., the shared attitudes and social cohesiveness of the members, facilitated the achieving of common goals.

The authors describe a program that is directed at assuring effective treatment and referral for alcoholic and addicted patients in a general hospital; the program was developed to assure maximal utlization of available addiction treatment facilities without adding to the hospital staff. Drawing on systems theory, the authors review both a pragmatic and a conceptual basis for psychiatric intervention with paraprofessional support to provide consultation to the general medical staff who treat alcoholic and addicted patients. They stress the feasibility of altering the nature of the hospital system to achieve more effective treatment for these patients.

Of 66 persons who left the Unification Church (the "Moonies"), twenty-three (36%) reported that they had had serious emotional problems after leaving. After an average of 3.8 years, however, the former members studied here had apparently achieved a stable adjustment. Most of them retained a notable fidelity toward the sect and its beliefs, but those who had been "deprogrammed" had more negative views and themselves had coerced other members to leave. The author examines the impact of group membership on individual development and looks at departure in relation to the psychopathology, such as depression and paranoid ideation, that may emerge.

A 3-year follow-up of longtime engaged members of the Unification Church revealed remarkable compliance with the sect's unusual marital commitments. Of 305 subjects, 95% were still active in the church and 85% had been married in the interim to mates designated by their religious leader. Their scores on a measure of psychological well-being remained below those of the general population, and members who deviated from the sect's expectations showed even greater distress. Furthermore, analysis revealed that affiliative ties with the sect apparently counteracted the distress produced by the unusual marital experience and help to explain compliance with the sect's unusual behavioral norms.

In a controlled study of Recovery, Inc., a self-help program for people with psychiatric problems, the author found a decline in both symptoms and concomitant psychiatric treatment after subjects had joined the group. Scores for neurotic distress reported after joining were considerably lower than those reported for the period before joining. Scores for psychological well-being of longstanding Recovery members were no different from those of community control subjects, and fewer long-term members than recent members were being treated with psychotropic medication and psychotherapy. The author concludes that peer-led self-help groups have value as an adjunct to psychiatric treatment.

The author discusses the new discipline of sociobiology. He develops the hypothesis that relief of neurotic distress may be associated with experiencing social affiliation and presents data that demonstrate a decline in neurotic symptom intensity in individuals who joined a cohesive religious sect. Anthropological and ethological evidence for the adaptive value of this "relief effect" provides a basis for the evolution of this trait. The author proposes a corresponding model for psychotherapy in large groups.

The authors conducted a survey of psychiatric education in alcoholism and drug abuse in the United States. Ninety-seven percent of 106 undergraduate training programs and 91% of 169 residency programs offered curriculum units in this field. Most of these programs also provided supervised clinical care. Areas of reported faculty dissatisfaction included problems with attitude and interest of psychiatric faculty and with the amount of curriculum time allotted. The authors conclude that although the amount of curriculum time devoted to training in alcoholism and drug abuse is growing, further investment in developing faculty and fellowships is warranted to increase the quality of teaching commitment.