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Fundamental approaches bypass the problem of getting consciousness from non-conscious components by positing that consciousness is a universal primitive. For example, the double aspect theory of information holds that information has a phenomenal aspect. How then do you get from phenomenal information to human consciousness? This paper proposes that an entity is conscious to the extent it amplifies information, first by trapping and integrating it through closure, and second by maintaining dynamics at the edge of chaos through simultaneous processes of divergence and convergence. The origin of life through autocatalytic closure, and the origin of an interconnected worldview through conceptual closure, induced phase transitions in the degree to which information, and thus consciousness, is locally amplified. Divergence and convergence of cognitive information may involve phenomena observed in light e.g. focusing, interference, and resonance. By making information flow inward-biased, closure shields us from external consciousness; thus the paucity of consciousness may be an illusion.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jsat.2008.07.001 Byline: Sandra Lapham (a), Robert Forman (b), Mark Alexander (b), Ari Illeperuma (b), Michael J. Bohn (c) Keywords: Abstinence; Alcohol; Alcohol dependent; Extended-release naltrexone; Holiday drinking Abstract: A post hoc analysis examined the effect of extended-release naltrexone (XR-NTX) treatment combined with psychosocial support on alcohol consumption during holiday and nonholiday periods in a cohort of alcohol-dependent patients who had maintained at least 4 days of continuous abstinence before receiving their first treatment. Three parameters of drinking behavior were examined: percentage of drinking days, percentage of heavy drinking days, and the number of drinks per day. Patients receiving XR-NTX 380 mg reported significantly lower median percentages of drinking days, heavy drinking days, and the number of drinks per day compared with the placebo group. Patients treated with XR-NTX 190 mg reported similar results overall. The results suggest that treatment with XR-NTX 380 mg in combination with psychosocial intervention leads to significant reductions in alcohol consumption, with some measures indicating abstinence in alcohol-dependent patients with initial abstinence during holiday periods. Author Affiliation: (a) Behavioral Health Research Center of the Southwest, a Center of the Pacific Institute for Research and Evaluation, Albuquerque, NM 87110, USA (b) Alkermes, Inc., Cambridge, MA 02139, USA (c) Aurora Psychiatric Hospital, Wauwatosa, WI 53213, USA Article History: Received 5 May 2008; Revised 11 July 2008; Accepted 14 July 2008

A study was conducted to determine the efficacy of short-term buprenorphine-naloxone as against detoxification as a form of treatment of opioid-addicted youth. Results indicated that continuing treatment with buprenorphine-naloxone showed improved outcome as compared to detoxification in treating opioid-addicted youth.

We report here on the feasibility of implementing a semiautomated performance improvement system--Patient Feedback (PF)--that enables real-time monitoring of patient ratings of therapeutic alliance, treatment satisfaction, and drug/alcohol use in outpatient substance abuse treatment clinics. The study was conducted in six clinics within the National Institute on Drug Abuse Clinical Trials Network. It involved a total of 39 clinicians and 6 clinic supervisors. Throughout the course of the study (consisting of five phases: training period [4 6weeks], baseline [4 weeks], intervention [12 weeks], postintervention assessment [4 weeks], sustainability [1 year]), there was an overall collection rate of 75.5% of the clinic patient census. In general, the clinicians in these clinics had very positive treatment satisfaction and alliance ratings throughout the study. However, one clinic had worse drug use scores at baseline than other participating clinics and showed a decrease in self-reported drug use at postintervention. Although the implementation of the PF system proved to be feasible in actual clinical settings, further modifications of the PF system are needed to enhance any potential clinical usefulness. reserved. Keywords: Performance improvement; Substance abuse; Feedback; Alliance; Treatment satisfaction

In the field of clinical alcohol disorders treatment in North America, abstinence continues to be largely viewed as the optimal treatment goal; however, there is a growing awareness of limitations when abstinence is considered the only successful outcome. Although this issue has been discussed in research settings, new studies on the public health significance of heavy drinking (defined as five or more standard drinks per drinking day in men, and four or more standard drinks per drinking day in women) in the past 10 years suggest that clinical providers should consider the value of alternative outcomes besides abstinence. A focus on abstinence as the primary outcome fails to capture the impact of treatment on reduction in the pattern and in the frequency of alcohol consumption. In addition, evaluating reduction in drinking as 'positive' has value for patients as an indicator of clinical progress. Measurement of continuous variables, such as the quantity and the frequency of alcohol consumption, has provided a clearer understanding of the scope of alcohol-related morbidity and mortality at the societal level, and of the relationship between individual patient characteristics and the naturalistic course of alcohol use, abuse, and dependence. A review of these characteristics suggests that there are clinical benefits associated with reducing heavy drinking in alcohol-dependent patients. Given the significant public health consequences associated with heavy drinking and the benefits associated with its reduction, it is proposed that researchers, public health professionals, and clinicians consider using reduction in heavy drinking as a meaningful clinical indicator of treatment response, and that outcomes be individualized to patients' goals and readiness to change. Keywords: Substance abuse; Outcomes; Evaluation; Treatment response; Health effects

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jsat.2005.08.013 Byline: Susan M. Gordon (a), Robert F. Forman (b), Candis Siatkowski (c) Keywords: Controlled substance; Drug source; Internet Abstract: Despite growing evidence that the internet is a source of controlled substances for nonmedical use, there is a lack of information about who is using it to obtain these drugs. One hundred adult drug-dependent inpatients in a private residential treatment program participated in a semistructured interview regarding how they obtained their drugs. Twenty-nine percent reported knowledge of the internet as a source of drugs, and 11% reported that they had used the internet to either buy drugs or locate a drug dealer. The results of this preliminary study suggest that the internet has become a source of controlled substances for some addicted individuals. Considerations for future research and clinical practice are described. Author Affiliation: (a) Seabrook House, P.O. Box 5055, Seabrook, NJ 08302, USA (b) Alkemes, Cambridge, MA 92139, USA (c) Caron Treatment Centers, Wernersville, PA 92139, USA Article History: Received 26 August 2004; Revised 5 August 2005; Accepted 10 August 2005

Several instruments for diagnosing substance use disorders (SUD) have been developed, but to date none has emerged as the standard for community-based clinical studies. To select the most suitable SUD diagnostic instrument for its clinical trials, the National Drug Abuse Treatment Clinical Trials Network (CTN) implemented a procedure in which 36 university-based addiction researchers and 62 community-based addiction treatment providers evaluated and ranked five widely recognized diagnostic instruments: (1) the SUD section of the Structured Clinical Interview for DSM-IV (SCID); (2) the SUD section of the Composite International Diagnostic Interview, 2nd ed. (CIDI-2); (3) the SUD section of the Diagnostic Interview Schedule for DSM-IV Diagnosis (DIS-IV); (4) the Diagnostic Statistical Manual-IV Checklist (DSM-IV Checklist); and (5) the Substance Dependence Severity Scale (SDSS). To assist the evaluation and ranking process, key characteristics of each instrument were presented in tabular and narrative formats. Participants ranked each instrument from 1 (most preferred) to 5 (least preferred). The SCID received the best overall mean score (2.24) followed by the CIDI-2 (2.59), DIS (2.94), DSM Checklist (3.40) and the SDSS (3.83). After discussing the pragmatic and scientific advantages and disadvantages of each instrument, the CTN Steering Committee selected the CIDI-2. The selection of the CIDI-2 standardizes the collection of diagnostic data and provides a common diagnostic tool for practitioners and clinical researchers in the CTN. Implications for practice/research collaboration and initiatives are explored. Keywords: Substance use disorder; Assessment; Diagnosis; Clinical trials

Staff from 10 community-based addiction treatment organizations in the National Drug Abuse Clinical Trials Network participated in an educational session about addiction research practices and human subject protections. This 1.5-hour presentation addressed 'informed consent,' 'confidentiality of research information,' 'inclusion and exclusion criteria,' 'random assignment,' 'patient protections,' and 'patient payments.' Pre- and postsession surveys were administered to 115 staff members measuring their beliefs about clinical trials. At baseline, 52% of staff believed patients could transfer out of a study even if they were doing poorly, and 55% believed staff had this right; 44% agreed that patients could participate in a clinical trial without understanding what would take place in the study. After the educational session, staff beliefs about patient protections were significantly increased in five of the seven items. A fourth of staff continued to believe patient payments were harmful, and 37% did not believe participation in a clinical trial would increase a patient's chances at recovery. Keywords: Staff beliefs; Addiction; Human subjects protection; Ethics; Clinical Trials Network

A number of factors keep college alumni staff and development officers from forging cooperative relationships, and campus and graduates suffer as a result. These factors include competition for resources and professional opportunities and stereotypes of administrator roles and characteristics. Successful partnerships require shared values and mutual appreciation of roles. (MSE)

The belief that mystical experiences occur in the same way that other experiences such as observing a pencil occur is based on the assumption that consciousness is inherently conceptual. However, the existence of pure consciousness events, where a person is conscious without having any thoughts, denies this assumption and requires a new model of mystical experience that is not founded on language and conceptualization. These experiences are described using language because of human inability to articulate in other ways regardless of consciousness states.