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The high prevalence of post traumatic stress disorder (PTSD) among people with heroin dependence and its impact on short term outcomes has been well established. The impact of PTSD on long-term recovery is, however, unknown. This paper examines the impact of current and lifetime PTSD on long-term recovery from heroin dependence among participants who took part in the 11-year follow-up of the Australian Treatment Outcome Study (ATOS), a prospective naturalistic longitudinal study of 615 people with heroin dependence recruited from Sydney, Australia, in 2001-2002. Seventy-one percent of the cohort (n = 431) were re-interviewed 11-years post study entry. Outcomes examined included heroin and other drug use, dependence, general physical and mental health, depression, PTSD, employment, and the incidence of trauma exposure, overdose, imprisonment, and attempted suicide over the 11- year follow-up. Despite having a poorer profile at baseline, individuals with current PTSD or a history of PTSD at baseline demonstrated similar levels of improvement to those without a history of PTSD in all outcome domains across the 11-year follow-up, PTSD was associated with consistently higher levels of major depression, and attempted suicide, subsequent trauma exposure, and poorer occupational functioning across the 11-year follow-up. These findings highlight the importance of interventions aimed at occupational rehabilitation, reducing the likelihood of retraumatisation, and addressing PTSD and associated comorbidities among people with heroin dependence. [ABSTRACT FROM AUTHOR]

Background: Many studies suggest that participation in 12-step groups contributes to better recovery outcomes, but people often object to such groups and most do not sustain regular involvement. Yet, research on alternatives to 12-step groups is very sparse. The present study aimed to extend the knowledge base on mutual help group alternatives for those with an alcohol use disorder (AUD), sampling from large, active, abstinence-focused groups including Women for Sobriety (WFS), LifeRing, and SMART Recovery (SMART). This paper presents a cross-sectional analysis of this longitudinal study, using baseline data to describe the profile and participation characteristics of attendees of these groups in comparison to 12-step members.Methods: Data from participants 18 and over with a lifetime AUD (N=651) were collected using Web-based surveys. Members of alternative 12-step groups were recruited in collaboration with group directors, who helped publicize the study by emailing meeting conveners and attendees and posting announcements on social media. A comparison group of current (past-30-day) 12-step attendees was recruited from an online meeting hub for recovering persons. Interested parties were directed to a Webpage where they were screened, and eligible participants completed an online survey assessing demographic and clinical variables; in-person and online mutual help involvement; and group satisfaction and cohesion. Analyses involved comparing those identifying WFS, SMART, and LifeRing as their primary group to 12-step members on the above characteristics.Results: Compared to 12-step members, members of the mutual help alternatives were less religious and generally higher on education and income. WFS and LifeRing members were also older, more likely to be married, and lower on lifetime drug and psychiatric severity; meanwhile, LifeRing and SMART members were less likely to endorse the most stringent abstinence goal. Finally, despite lower levels of in-person meeting attendance, members of all the 12-step alternatives showed equivalent activity involvement and higher levels of satisfaction and cohesion, compared to 12-step members.Conclusions: Results suggest differences across 12-step groups and their alternatives that may be relevant when advising clients on a choice of mutual help group. Meanwhile, findings for high levels of participation, satisfaction, and cohesion among members of the mutual help alternatives suggest promise for these groups in addressing addiction problems. [ABSTRACT FROM AUTHOR]

Introduction: Chronic polysubstance abuse (SUD) is associated with neurophysiological and neuroanatomical changes. Neurocognitive impairment tends to affect quality of life, occupational functioning, and the ability to benefit from therapy. Neurocognitive assessment is thus of importance, but costly and not widely available. Therefore, in a busy clinical setting, procedures that include readily available measures targeting core cognitive deficits would be beneficial. This paper investigates the utility of psychometric tests and a questionnaire-based inventory to assess "hot" and "cold" neurocognitive measures of executive functions (EF) in adults with a substance use disorder. Hot decision-making processes are associated with emotional, affective, and visceral responses, while cold executive functions are associated with rational decision-making.Material and Methods: Subjects with polysubstance abuse (n=126) and healthy controls (n=32) were compared on hot (Iowa Gambling Task) and cold (Stroop and the Trail Making Test) measures of EF, in addition to a questionnaire assessing everyday EF related problems (BRIEF-A; Behavior Rating Inventory of Executive Function - Adult, self-report version). Information about the substance abuse and social adjustment were assessed by self-report. Logistic regression analyses were applied to assess independent correlates of SUD status and social adjustment. A multiple linear regression was performed to predict the number of previous treatment attempts.Results: The psychometric test of hot EF (the Iowa Gambling Task) did not differentiate the patients with polysubstance abuse from controls, and was not associated with social adjustment. The psychometric tests of cold EF distinguished somewhat between the groups and were associated with one indicator of social adjustment. The BRIEF-A differentiated between groups on all the clinical scales and was associated with three out of five social adjustment indicators ("criminal lifestyle," "conflict with caregiver," and "stable housing.").Conclusions: The BRIEF-A inventory was the most sensitive measure of executive function in patients with substance use disorder, followed by measures of cold executive function. BRIEF-A should therefore be considered as an integral part of the clinical routine when assessing patients with SUD. [ABSTRACT FROM AUTHOR]

Many drug abusers have repeated exposure to treatment, yet little is known about the reasons some individuals re-enter treatment following relapse to drug use. This paper examines the predictors of treatment re-entry among cocaine abusers who relapsed to cocaine use (N = 347) within 5 years following their index treatment episode. In-depth assessments were conducted at treatment intake in 1991–93 and at 1 and 5 years following treatment discharge. About 44% of the sample returned to treatment, at an average of 2.6 years following discharge. A logistic regression analysis demonstrated that individuals who were African American, were previously married, used cocaine at least weekly after treatment discharge, and had more service needs at the time of index treatment were more likely to re-enter treatment. The findings suggest that a longer-term perspective on treatment utilization is needed to more fully address chronic substance abuse and the problems typically associated with it. [Copyright &y& Elsevier]

This paper investigates alcohol outcomes and heavy drinking among 418 drug misusers from the National Treatment Outcome Research Study who completed followup interviews at 1, 2, and 4–5 years. About a quarter of the sample were drinking heavily at intake. Alcohol consumption at followup was predicted by drinking prior to intake, and about a quarter of those who were classified as alcohol abstainers, medium-level drinkers, or heavy drinkers at intake, remained in the same drinking category at all assessment points. Drinking outcomes were not related to opioid use. Heavy drinkers at followup were more likely to be using non-opioid drugs. The poor drinking outcomes are a matter for concern. Drug misusers with concurrent alcohol problems may require special treatment provision. The extent of heavy drinking among drug misusers both before and after treatment indicates a need to develop and strengthen programs and interventions to tackle alcohol-related problems in this patient group. [Copyright &y& Elsevier]

Although there is a high prevalence of co-occurring mental and substance abuse disorders, and empirical evidence shows the need to integrate multiple treatment services for dually diagnosed persons, service integration is relatively recent and often poorly implemented. Moreover, service providers and clients often hold divergent views of what constitute appropriate and feasible treatment goals. This paper presents interview data from an urban sample of dually diagnosed members of self-help groups (N = 310) concerning the challenges confronting them in their recovery, and discusses the interrelations of these issues. The findings indicate that most clients struggle with emotional and socioeconomic issues, which bear significantly on their ability to handle adequately other aspects of recovery. [ABSTRACT FROM AUTHOR]

This paper reports results of a study that investigated whether matching drug treatment services with client needs improved outcomes for a sample of 171 clients who participated in community-based drug treatment programs. Clients were initially assessed on multiple problem areas (alcohol use, drug use, medical, psychological, family/social, legal, employment, housing) and on areas of special needs or stated preferences for services (e.g., transportation, child care, language). A 6-month follow-up interview reassessed clients' problems/needs in all areas and collected information on the services received. The results showed that some services significantly improved client outcome for those who had expressed needs for such services. Notably, services meeting the need for vocational training, child care, transportation, and housing showed beneficial effects. A higher level of needs and services matching (defined either by the ratio of services received to services desired, or by the total level of met versus unmet needs in the eight problem areas) significantly predicted longer treatment retention. [ABSTRACT FROM AUTHOR]

Alcohol and drug use in pregnancy is a significant concern. There is a paucity of treatment programs for substance-abusing pregnant women, especially if indigent. Furthermore, treatment retention is compromised when the drug of choice is crack-cocaine. This paper reports the results of a study comparing treatment retention of cocaine-abusing indigent pregnant women before and after incorporating pregnancy-specific interventions. Audits were performed on 603 charts of women enrolled between 1988 and 1994 in either a traditional treatment program (n = 114) or in the Pregnancy Substance Abuse Program (PSAP) (n = 489). Differences in treatment retention were found between the two treatment groups. Drop-out rates from the inpatient component of treatment were significantly lower in the PSAP group than in the control group (11.3% vs. 38.6%, p < .001). There was a higher rate of completion of outpatient treatment in the PSAP compared to the control group (34.4% vs. 13.5%, p < .005). These results were achieved with a 2-day decreased inpatient stay. Treatment retention improved when specialized interventions were provided, at minimal additional cost. These results have implications for other publicly funded treatment programs. [ABSTRACT FROM AUTHOR]