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The article compares the efficacy of cognitive behavior therapy (CBT) and enhanced usual care (EUC) as a means of improving the condition of elderly patients suffering from generalized anxiety disorders (GAD). CBT proves to bring greater results in improving the general mental health of elderly patients as compared to EUC.

Determining pre-treatment variables that predict attrition in an outpatient cocaine abuse program is critically important in efforts to enhance retention and ultimately improve client outcome. Potential predictors have been identified, such as treatment history, deviant behaviors, and level of drug use; however there is not widespread agreement on their applicability across treatments and populations. This study examines the relationship of demographic, drug use severity, and psychosocial factors with treatment attrition and the time of dropout. One hundred and sixty-five individuals from the Houston area, seeking treatment for cocaine dependence, completed a pre-treatment assessment battery prior to starting 12 weeks of outpatient treatment. A series of regression analyses showed that treatment dropouts were more likely to be separated from their spouses, have poorer family/social functioning, have fewer years of education, and to be female. Those participants with higher education levels and those with poorer psychiatric functioning tended to remain in treatment longer. The implications of these findings are discussed., INTRODUCTION Patient attrition is a serious problem facing most drug treatment programs today. With dropout rates averaging 55% in such programs, efforts are now being made to further examine variables [...]

An assessment is presented of the Brief Psychiatric Rating Scale (BPRS-A), focusing on internal consistency, interrater agreement, and rater influence for the nonoverlapping subscales of resistance, psychological discomfort, positive symptoms and negative symptoms. The pros and cons of using BPRS-A are discussed.

Monetary reinforcers have not been widely used as contingent reinforcers in the treatment of drug abuse, despite their demonstrated effectiveness. This is primarily due to concern that drug abusers will use monetary reinforcers to procure drugs. The present study addressed this concern by examining 48 cocaine-dependent outpatients' biweekly self-reports of how they used their earned reinforcers. For each subject, their reinforcement usage was classified into 12 higher-order categories and 34 subcategories. Usage proportions were calculated for each. Results indicated that monetary reinforcers were used very infrequently to acquire drugs or alcohol (2%). Reinforcers were used primarily for daily life activities (25%) (e.g., food and gas), money-related uses (18%) (e.g., savings and repaying debts), personal use (15%) (e.g., cosmetics and clothes), and household items (11%) (e.g., rent and bills). These findings challenge the concern that drug abusers use monetary reinforcers to purchase drugs and have important implications for the use of contingent monetary reinforcers in treatment settings.

The relative effectiveness of adjunctive contingency management measures in maintaining abstinence from cocaine use and enhancing compliance with prenatal care has been studied. Pregnant cocaine-dependent women who had used the drug during the pregnancy, but had stopped prior to study entry were selected. The multifaceted treatment included prenatal visits and behaviour-based drug counselling. The rate of retention and abstinence from cocaine in the two groups was high, although there was a higher rate of attendance at prenatal visits by patients in the experimental group.

We examined the effectiveness of behavioral interventions in the treatment of cocaine-dependent pregnant women. The study was carried out in four stages: (1) the unique needs of substance-abusing women were examined to identify effective treatment factors, (2) behavioral interventions found to be effective in other cocaine-dependent populations were identified, (3) strategies from these two elements were combined in an ongoing treatment-study of cocaine-dependent pregnant women (the Pregnancy Project), and (4) outcome data in a group of 35 women who participated in the Pregnancy Project were examined. The rate of retention in treatment was high, as was compliance with prenatal care for those women who remained in treatment. A high rate of compliance with prenatal care was associated with good perinatal outcome. There was a relatively high rate of cocaine abstinence during treatment, at birth, and in the early period following birth of the baby. Many of the patients especially appreciated the individually based, self-empowering aspects

Relapse has gained prominence as theoretically sound approach for substance-abuse treatment. Several cocaine-dependent respondence were assessed to investigate the role of treatment modality in relapse prevention treatment and to compare the effectiveness of group versus individual therapy. The study reveals that although both individual and group treatments possess certain unique features that might enhance client's response to relapse prevention, group therapy proves to be less expensive than individual therapy.

Results of two preliminary studies examining the efficacy of the contingency management procedure (shaping) on decreasing cocaine use and increasing compliance with the prescribed medical regimen in two high-risk cocaine-dependent population, tuberculin-exposed patients and pregnant women, are described. Monetary reinforcers were effective in reducing cocaine consumption.

A within-subjects study of five cigarette smoking methadone maintenance patients revealed that monetary incentives had minimal effects in mitigating their carbon monoxide intake levels. This result has important implications in shaping contingency management procedures in smoking cessation programs.

A study of cocaine-dependent pregnant women reveals that those who received 'baseline' drug treatment were more successful in the cessation of cocaine when compared to those taking 'intensive' drug treatment. Pregnant women taking 'baseline' treatment enjoy a better success rate because of their decision to abstain from cocaine prior to starting treatment and due to their concern for the baby. Pregnant women taking 'intensive' treatment require more time to stop cocaine intake.

This study demonstrates the use of paired comparisons and interval scaling techniques for measuring the relative priority of program Privileges available at a methadone maintenance clinic. Fifteen methadone program privileges were combined in all possible pairs (N = 105) on a reinforcer menu and administered to a group of 12 methadone patients and a second group of counselors (N = 4). Data were converted to interval scales using the law of comparative judgment to form a quantitative continuum from least to most preferable. Free methadone, free dental service, and more take-homes were ranked highest in both groups; however, patients showed less differentiation in their preference for these privileges. Dose decreases were least preferred. Results are discussed in terms of their clinical applicability in identifying privileges for potential use in modifying the behavior of drug abusers. The method of paired comparisons has excellent psychometric properties and may offer some advantages over other response scale formats. Keywords -- methadone maintenance; reinforcer; contingency; paired comparisons; interval scaling; behavioral-pharmacological interventions.

Tuberculosis has increased dramatically in the United States. Noncompliance with treatment is high. The purpose of this investigation was to achieve compliance with prophylactic TB treatment and simultaneously decrease drug use in a high-risk group of intravenous drug users. Two studies were conducted. Study 1: Subjects were 9 chronic opiate users who tested positive for tuberculosis and were placed on isoniazid (INH) and methadone. Methadone was dispensed contingent upon INH ingestion throughout. A within-subject, A-B design with contingency management interventions on drug use was implemented. Results: Compliance with INH was 100% in 8 patients. Cocaine use remained high. Study 2: Two patients, meeting same criteria as Study 1, participated in a within-subject A-B multiple baseline design. Methadone was dispensed contingent upon INH ingestion throughout. Successive decreases in cocaine use were reinforced in the contingent phase. Results: Compliance with INH was high. During contingency, both patients had over 40% cocaine-free urine samples compared with 0% at baseline. This investigation serves as a model for achieving compliance with TB treatment in opiate users.

The Diagnostic Inventory of Personality and Symptoms (DIPS; Vincent, 1985) is a self-rating instrument that yields 14 clinical scale scores and a validity scale score. The scale scores present diagnostic classification information derived from major DSM-III diagnostic categories. This study replicates and extends a previous factor study by Vincent and Duthie (1986). DIPS data were collected from 170 psychiatric inpatients and outpatients. Both a principal components analysis and an oblique, cluster-oriented, marker variable factor analysis of the 14 clinical scale scores resulted in four factors, the first three of which reproduced the pattern of factor loadings found by Vincent and Duthie (1986). The results support the existing distinction between DSM-III Axis I psychotic and neurotic disorders, and Axis II characterological disorders.

Abstract Nonhuman and human studies have shown that benzodiazepine (BZD) receptor agonists can modify aggressive behaviour. However, it is unknown whether flumazenil, a BZD receptor antagonist, enhances or inhibits aggressive [...]