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Sixty individuals referred for a substance abuse evaluation by a child welfare worker were randomly assigned to either a standard evaluation or an evaluation enhanced by Motivational Interviewing techniques, each delivered in a single session. Participants who received the enhanced evaluation were significantly more likely to attend at least one additional treatment session after the initial evaluation (59% versus 29%). This finding suggests that comparatively inexpensive modifications of "standard" initial evaluations with substance-using parents may increase engagement of substance-abusing parents in treatment. Moreover, this study adds to an overwhelmingly positive literature supporting Motivational Interviewing with alcohol-using populations and extends prior findings to non-research community settings. [ABSTRACT FROM AUTHOR]

This pilot study reports the relative efficacy of a one-session preadmission motivational interview (n = 13) compared to a standard preadmission interview (n = 10) for psychiatrically ill substance abusing patients in a partial hospital program. [ABSTRACT FROM AUTHOR]

This study examined gender differences in demographics, psychosocial functioning, substance abuse severity, psychopathology, and 1-year outcome in cocaine-dependent patients with the goal of identifying factors important to improving treatment and identifying prognostic indicators. The sample included 298 cocaine-dependent adults (92 women). Ninety-four patients (29 women) provided 1-year follow-up assessments. Compared to men, women consumed similar quantities of cocaine by more addictive routes and experienced more rapid progression of drug dependence, thus highlighting the need to facilitate treatment entry. The substantial rates of positive treatment outcomes emphasizes the effectiveness of treatment for cocaine-dependent individuals. [ABSTRACT FROM AUTHOR]

Objective: To determine the feasibility of primary care-based ambulatory opioid detoxification (AOD) using two protocols: clonidine and clonidine plus naltrexone.Setting: The Central Medical Unit (CMU)--a freestanding primary care medical clinic staffed by physicians and nurse practitioners.Patients: Injection drug users (IDUs) seeking substance abuse treatment between the ages of 18 and 50 years who were addicted to opioids (e.g., heroin) and not currently in drug treatment.Interventions: In the clonidine protocol, clonidine was administered every 4 hours "as needed" for up to 12 days. In the clonidine plus naltrexone protocol, clonidine was administered and naltrexone was administered in increasing doses over five days. Both protocols included "adjuvant" medications for muscle cramps, insomnia, and vomiting. Successfully detoxified patients were referred to ongoing drug treatment.Design: A prospective nonrandomized clinical trial.Measurements and Main Results: One hundred forty opioid-addicted IDUs were referred to the medical clinic for AOD. Among the 125 patients who enrolled in the study, 57 selected clonidine and 68 selected clonidine/naltrexone. The treatment groups (clonidine vs clonidine/naltrexone) were similar at baseline with respect to: age at first heroin use (21 years vs 23 years), mean admission opioid craving score (45/100 vs 49/100), and withdrawal symptom score (19/72 vs 18/72). Overall, 70% (88/125) of the AODs were successful, including 42% (24/57) for clonidine and 94% (64/68) for clonidine/naltrexone (p < 0.001).Conclusions: This study suggests that primary care-based AOD can be safely and effectively carried out by primary care providers and that clonidine/naltrexone may be more effective in this setting than is clonidine alone. Ambulatory opioid detoxification can give internists a larger role in initiating drug treatment for IDUs who are addicted to opioids. [ABSTRACT FROM AUTHOR]

Background: Opioid detoxification in a primary care setting followed by ongoing substance abuse treatment may be appropriate for selected opioid-dependent patients.Objective: To compare three pharmacologic protocols for opioid detoxification in a primary care setting.Design: Randomized, double-blind clinical trial with random assignment to treatment protocols.Setting: A free-standing primary care clinic affiliated with drug treatment programs.Patients: 162 heroin-dependent patients.Interventions: Three detoxification protocols: donidine, combined donidine and naltrexone, and buprenorphine.Measurements: Successful detoxification (that is, when study participants received a full opioid-blocking dose [50 mg] of naltrexone), treatment retention (8 days), and withdrawal symptoms.Results: Overall, 65% of participants (36 of 55) who received clonidine, 81% (44 of 54) who received combined clonidine and naltrexone, and 81% (43 of 53) who received buprenorphine were successfully detoxified. Retention did not differ significantly across the groups: 65% of participants (36 of 55) who received clonidine, 54% (29 of 54) who received combined clonidine and naltrexone, and 60% (32 of 53) who received buprenorphine. Participants who received buprenorphine had a significantly lower mean withdrawal symptom score than those who received clonidine or combined clonidine and naltrexone.Conclusions: Participants in the combined clonidine and naltrexone group and those in the buprenorphine group were more likely to complete detoxification, although retention at 8 days did not differ among the groups. Participants who were assigned to the buprenorphine group experienced less severe withdrawal symptoms than those assigned to the other two groups. [ABSTRACT FROM AUTHOR]