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The high cost of incarceration and a genera/confidence in the effectiveness of drug abuse treatment have led many states to adopt community-based drug abuse treatment as part of, or as an alternative to, incarceration. Community re-entry and aftercare have therefore received increasing attention from both practitioners and researchers. This article examines possibilities for encouraging change in both adult and juvenile justice treatment. Four issues are highlighted: (1) relapse and aftercare, (2) co-occurring disorder, (3) juvenile justice programming, and (4) womenis treatment. The success of U. S. drug treatment policy depends on a capacity to resolve these and related issues.

This study examined whether Motivational Interviewing (MI), found effective with voluntary entrants to drug treatment, would improve intrinsic motivation and treatment retention among drug court probationers. Probationers were randomly assigned to receive either a two-session MI intervention or a two-session Drug Education (DE) intervention preceding drug-free outpatient counseling. Participants who received MI (n = 72) did not differ from participants who received DE (n = 68) nor from participants who did not attend either MI or DE sessions (n = 56) on changes in motivation during the first month of treatment or in treatment retention. Baseline motivation was inversely related to time in treatment; however, motivation after one month of treatment, and change in motivation from baseline to one month, were independently and positively related to treatment retention. KEYWORDS drug-free outpatient treatment, motivation, motivational interviewing, treatment retention

This study examined correlates of high (HCA) and low (LCA) cognitive ability among substance dependent individuals who participated in an ongoing study of early engagement strategies. Participants (55% male; 98% African American), were administered the ASI, Shipley Institute of Living Scale, Beck Hopelessness scale, and TCU Motivation Scales at intake. Analyses were limited to 416 participants whose IQs fell within the upper and lower thirds of the sample. HCA participants reported more prior treatment episodes and longer durations of voluntary abstinence than LCA participants. There were no differences in retention, although HCA participants expressed significantly greater motivation and hopefulness at intake than LCA participants. Results indicate that clients with higher cognitive ability may present with a greater capacity to engage in treatment than individuals with lower cognitive ability. Keywords: Cognitive ability, motivation, engagement, cognitive behavioral therapy, outpatient treatment, INTRODUCTION Poor psychological functioning may negatively impact treatment engagement and outcomes of treatment-seeking substance dependent individuals. One aspect of psychological functioning among substance dependent clients, that of cooccurring mental health [...]

Retention in outpatient drug-free treatment is poor, with many clients terminating prior to receiving therapeutic benefit. This randomized clinical trial compared the impact on retention and drug use of an individual role induction session conducted at intake with the standard group orientation offered at the clinic. Results of interim analyses indicated that participants assigned to role induction (n = 180) were retained for more days, more likely to attend at least one postorientation session, and more satisfied with the treatment program than were those assigned to standard treatment (n = 87). Preliminary results suggest that role induction is a brief technique that shows promise for retaining clients through the critical first 3 months of treatment.

A study of the relationship of heavy alcohol intake to response to methadone treatment revealed that alcohol-dependent individuals are likely to be in treatment longer than nondependent drinkers. Differences in studies of treatment outcome may be accounted for by the failure to distinguish between nondependent and dependent drinkers.

This study was conducted to investigate the relationship between the indicators of psychiatric disorders of individuals and their choice of either cocaine or heroin, drugs that differ markedly in their pharmacological effects, Cocaine acts as an intense stimulant, and heroin has profound sedative effects. This investigation examined the relationship between preference for heroin or cocaine and indicators of psychiatric impairment. Data from 282 subjects were grouped according to drug of choice and analyzed. Ninety-three percent of these subjects were African-American, 32% were female, and the average age was 34. Univariate and multivariate statistical analyses, such as discriminant analyses, were used to determine group differences. The results are evaluated and interpreted in relation to both the current empirical findings and to the hypotheses and theories postulated as a result of earlier clinical observations on drug of choice and psychopathology. Discriminant analysis yielded an overall correct classification rate of 75%. The discriminant function suggests that members in the cocaine drug of choice group as contrasted with members in the heroin preference group can be characterized as more socially inhibited and more self-defeating after adjusting for differences in age, duration of use of illicit substances, and marital status. Those who favored cocaine as contrasted with those who favored heroin were more likely to have never married, be younger, and have used illicit substances for a shorter period of time., INTRODUCTION Clinical differences have been found between subgroups of drug abusers when grouped according to drug of choice[1]. Questions have been raised regarding the diagnoses of persons electing to become [...]

We interviewed 70 substance abusers in methadone maintenance treatment regarding the life experiences of their 188 children. Sixty-four percent of the mothers reported using psychoactive drugs during their pregnancies. Eighty percent of parents reported an arrest during the time the child was growing up, 34% reported receiving treatment for an emotional disorder, and 14% were hospitalized. Four percent of the parents reported that their children had been placed in adoptive care, 9% in foster care, and 1% had a child in a group home. Forty-one percent of the parents reported that at least one of their children repeated a grade in school, 19% were involved in truancy, and 30% had been suspended from school. Twenty percent of parents reported their children's involvement with the law, and 17% reported drug or alcohol use. Problems with the law correlated highly with 1) being held back a grade, 2) truancy, 3) suspension from school, 4) expulsion from school, and 5) treatment for alcohol or drug abuse., INTRODUCTION Over the last 10 years there has been great concern with understanding the needs, personality characteristics, and treatment of children of alcoholics (COAs). The grassroots Adult Children of Alcoholics [...]

One of the high risk groups for contracting human immunodeficiency virus (HIV) infection, the agent that causes AIDS, is intravenous (IV) drug users. It is the second highest group to develop AIDS as well. Early identification of HIV infection is advocated because there is increasing evidence that early intervention can be beneficial. However, the attitudes of drug treatment counselors toward HIV testing are often ambivalent. Many have concerns about a client's emotional response to a positive test result. Therefore, there is a need to study the psychological reactions of addicts who are informed that they are HIV-seropositive. One question is whether or not such clients will remain in treatment after getting such a test result. If a person reacts to an HIV-seropositive test result with a sense of hopelessness and discouragement, he may be likely to drop out of treatment. On the other hand, an HIV-seronegative test result may also cause treatment dropout by reinforcing denial of the need for treatment. The present investigation compared two groups of 22 cocaine abusers in drug abuse treatment, matched for age, gender, race, education, sexual preference, cocaine use, and other factors. The average age of subjects in each group was about 31 years; there were 19 males and 3 females in each group; 17 subjects in each group were Black, and 5 subjects in each group were White. One group was HIV-seronegative and the other was HIV-seropositive. Mood and retention in treatment were monitored. Subjects were treated for up to 12 weeks with medication and received psychotherapy twice a week. HIV-seropositive subjects stayed in treatment an average of 5.7 weeks, while HIV-seronegative subjects dropped out, on average, 5.1 weeks after treatment began. This difference in retention was not significant. HIV-seropositive subjects reported more emotional distress than did HIV-seronegative subjects but 'anger/hostility' was the only dimension that significantly differed between them. Overall, there were little or no differences in mood or treatment retention between HIV-seropositive and HIV-seronegative cocaine addicts in this study. It is recommended that drug abuse counselors should be less ambivalent about HIV-serostatus testing, and that they respond to the needs of HIV-seropositive clients by integrating HIV counseling into their programs. (Consumer Summary produced by Reliance Medical Information, Inc.), INTRODUCTION Intravenous (IV) drug users are a major risk group for being infected with human immunodeficiency virus type-1 (HIV-1) and represent the second highest risk group to become ill with [...]

We conducted a single-blind, random assignment, placebo-controlled, 12-week comparison of of desipramine hydrochloride and amantadine hydrochloride as adjunctive treatments to counseling for cocaine dependence. Subjects were 54 outpatients who met DSM III-R criteria for active cocaine dependence and who completed a minimum of 2 weeks of treatment. Subjects treated with fixed doses of 200 mg/day desipramine (N = 17), 400 mg/day amantadine-placebo (N = 16), and placebo (N = 21) did not differ for lifetime cocaine use, lifetime histories of psychopathology, admission scores on psychometric assessments, and sociodemographics. All treatment groups demonstrated dramatic and persistent decreases in cocaine use, craving for cocaine, and psychiatric symptoms consequent to treatment. Although there was a trend for more dropouts by subjects taking desipramine, there were no significant differences among treatment groups regarding retention in treatmet, craving for cocaine, and decreased cocaine use confirmed by urine toxicology. There was a trend for subjects treated with desipramine to maintain longer periods of cocaine abstinence. Mean plasma concentration of desipramine in a subsample of our subjects was less than that recommended for treatment of depression, thus the dosage of desipramine may have been subtherapeutic., A 1986 report by the National Institute for Drug Abuse estimated that 3 million people were abusing cocaine. This underscores the need for treatment interventions addressing the psychosocial and physiological aspects of cocaine dependence. Mood and sleep disturbances, irritability, and a craving for cocaine are some of the withdrawal symptoms commonly seen in those who stop the drug. Desipramine, an antidepressant, and amantadine, a drug used to treat symptoms of Parkinson's disease, have been found to be somewhat useful in the treatment of cocaine-related withdrawal symptoms, but they have never been compared with each other from efficacy. Over a 12-week period, 54 cocaine-dependent subjects receiving outpatient psychotherapy were assigned to one of three groups. The 17 subjects in group one received 200 milligrams (mg) per day of desipramine; the 16 subjects in group two received 400 mg/day amantadine; and the 21 remaining subjects received a placebo. All subjects continued psychotherapy. Pre-trial data revealed that all subjects had similar cocaine use patterns, psychiatric histories, and sociodemographic backgrounds. While those treated with desipramine had longer periods of cocaine abstinence during the duration of the study, there were no statistically significant differences between any groups on measures of retention in treatment, cravings for cocaine, and overall decrease in cocaine use. All groups showed evidence of decreased cocaine use and craving. (Consumer Summary produced by Reliance Medical Information, Inc.), INTRODUCTION Cocaine dependence is a major health problem in the United States, The National Institute on Drug Abuse (NIDA) reported that three million persons were abusing cocaine regularly by 1986 [...]

Comparison was made of treatment clients attending Narcotics Anonymous and/or Alcoholics Anonymous meetings less than weekly (n = 41) with treatment clients attending meetings at least three times a week (n = 30). The frequent attenders (attending an average of 30.6 meetings monthly) differed from non- and infrequent attenders (attending an average of 0.4 meetings monthly) in terms of histories of greater lifetime drug use, more arrests and treatment experiences, and an earlier age of first use of alcohol. Although the frequent attender was also older, age was not found to influence the differences found between groups. Measures of religiosity, use of community services, and support from others for recovery and psychological functioning, other than ratings of the helpfulness of 12-Step, were not differentiated among groups. The findings suggest that 12-Step groups are more likely to be selected by clients with more severe histories of drug use and criminal activity, i.e., those most in need of the support to behavior change those groups provide. The role of treatment programs in facilitating the use of 12-Step groups is discussed. Key Words: Aftercare; 12-Step; Narcotics Anonymous; Drug treatment; Criminal justice clients., INTRODUCTION Originating in 1935 and 1953, respectively, Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) have become community resources that are both well established and widely accessible. DuPont (1) reports there [...]

A review of recent study in drug abuse treatment suggests that by the 1980s there had developed a concern about melding drug abuse treatment techniques with strategies drawn from the field of mental health. The emergence of AIDS has made it necessary to augment treatment objectives to include containment of HIV infection as an appropriate goal and develop innovative strategies appropriate to achieving that goal. There is a review of new models of service delivery that can be initiated and/or have been initiated in three areas: outreach/recruitment of IV drug users and their cohabitants, education/counseling with regard to risk-reducing behaviors, and extending the period of treatment influence. The impact of AIDS on program administrators and line staff is also discussed.

Changes in the status of applicants to drug abuse programs, particularly the degree of their involvement with the legal system, drug use and attitude were analyzed. Applicants who were on a waiting list for less than three months had greater expectations that they would receive help, and possibly as an effect, had fewer arrests and drug involvement did not increase. Nearly half of the total sample reported significantly decreasing drug use when applying for treatment, but more than half of the applicants were pessimistic about their ability to remain drug free. Despite high levels of encouragement from significant others, half of the applicants reported becoming less interested in treatment. Forty percent of the applicants who were IV drug users knew someone who had contracted AIDS, and almost ninety percent changed behaviors of needle-sharing, to reduce their risk of infection. Applicants who were on waiting lists for six months reported a higher incidence of depression. Recommendations for early intervention and outreach services by treatment facilities is stressed. The use of a waiting list does not meet the needs of this unstable segment of the population., The Functioning of Individuals on a Drug Abuse Treatment Waiting List ABSTRACT Using structured interviews and the SCL-90R, study was made of the behaviors of 29 applicants to a residential [...]

Comparisons were made between cocaine-abusing volunteers at a cocaine research facility and similar subjects at a cocaine treatment facility. Persons who volunteered for the treatment facility were predominately caucasian, younger and more frequently married; there was also greater reporting of psychiatric problems, anger and resentment with this group. The research group, on the other hand, had greater instances of needle-sharing, risk-taking and property crimes such as burglary. The usefulness of these findings may be in determining the validity of self-reports from drug users, since the research group, who had used this method of reporting, had greater instances of non-conformative behaviors. Similarly, the severity of psychiatric symptoms among members of the treatment group may have a significant relationship to both their volunteering and their response to treatment., Comparison of the Characteristics and Functioning of Cocaine Treatment and Cocaine Research Subjects ABSTRACT Comparisons were made of the functioning and characteristics of cocaine-abusing volunteers to a research ward (N [...]