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A sample of 600 patients treated in a multimodal treatment program using aversion therapy and narcotherapy at three Schick freestanding addiction treatment hospitals and one Schick unit in a general hospital were followed-up. Contact was made a minimum of 12 months and as many as 20 months after completion of treatment (mean 14.7 mos.). Telephone contact was made by an independent research organization with 427 of the patients (71.2%). Of these, 65.1% were totally abstinent for 1 year after treatment and 60.2% were abstinent until follow-up a mean of 14.7 months later. Fifty-two percent of the alcoholics were using or dependent on other drugs at admission. Seventy-five of these treated for cocaine dependence and 47 treated for marijuana dependence. The cocaine 12 month and "total" abstinence (mean 14.7 mos.) rates for the 49 contacted patients were 83.7% and 81.6%, respectively. The marijuana 12 month and "total" abstinence (mean 14.7 mos.) rates for the 30 contacted patients was 70.0% for both groups. Abstinence rates for alcohol and/or other drugs were also calculated including noncontacted patients who had chart documented evidence of relapse. The most powerful predictor of success was whether or not all urges to drink or use had been eliminated (presumably by aversion therapy). Of additional importance was the use of support groups and reinforcement treatments after completion of the initial hospitalization. The two most prominent factors initiating a relapse were "intrapersonal determinants" such as stress from work or marriage/family relationships and "interpersonal determinants" such as being around others who were drinking/using or being at a celebration or special event. The two factors were of equal importance in the alcoholics. However, interpersonal determinants were far more important in the cocaine and marijuana treated patients. Increased utilization of reinforcement treatments was associated with decreased urges to drink/use and increased abstinence rates. In contrast, increased frequency of support group utilization was associated with increased urges to drink/use and lower abstinence rates. This suggests the need to take seriously patient reports of "urges" in the first year after treatment and to carefully assess the cause and initiate or update an individualized plan of treatment. Such treatment may include increased reinforcement treatments, treatment of depression, and additional assistance in coping with intrapersonal and interpersonal determinants of relapse.
J Subst Abuse Treat
PMID:Treatment outcome of 600 chemically dependent patients treated in a multimodal inpatient program including aversion therapy and pentothal interviews. 810 3

This study investigated the ability of four hypnotically induced mood states (euphoria, depression, anxiety, and anger) to trigger craving and other drug-related conditioned responses in detoxified opiate abuse patients. Hypnotically induced depression produced significant increases in drug craving for opiates. Depression also tended to increase global self-ratings of opiate withdrawal. Other trends included increases in self-rated craving by induced anxiety and increases in withdrawal symptoms by induced anger. These results suggest that negative mood states, perhaps in the context of repeated attempts at self-medication, may become conditioned stimuli capable of triggering craving and other drug-related conditioned responses. The ability of depression to produce reliable effects in this particular patient group may reflect the high lifetime prevalence of depression diagnoses for this sample. The implications of these findings for therapeutic strategies are discussed.
J Subst Abuse Treat
PMID:Can induced moods trigger drug-related responses in opiate abuse patients? 820 29

Young African-American women are the fastest growing group of crack cocaine users in the United States. Despite this increase, relatively little is known about women who use crack cocaine and the possible reasons for their drug use. This descriptive, exploratory study focused on data from a sample of 105, predominantly African-American women who use(d) crack cocaine, of whom 60 were in drug treatment and 45 were still using crack cocaine. Significant correlations were found between variables such as family drug use, first age of sexual abuse, age of first depressive symptoms and age of first illicit drug use. These data are consistent with other studies which have noted high rates of depression and sexual abuse in samples of predominantly Euro-American, alcoholic women. Implications for the treatment of women are discussed.
J Subst Abuse Treat
PMID:The antecedents of women's crack cocaine abuse: family substance abuse, sexual abuse, depression and illicit drug use. 824 16

In an exploration of changes that occur with initiation of cocaine abstinence, this study examined treatment outcomes in four domains--behavior (cocaine use), affect (depression), cognition (schematic self-representations), and psychophysiology (reactivity to drug cues). Nineteen patients initially entered this 8-week outpatient psychopharmacotherapy trial for the treatment of cocaine dependence. Thirteen completed treatment, and eleven maintained abstinence during the last four weeks of the study. In addition to a demonstrated change in their cocaine-using behavior, these "abstainers" reported reduced depression, increased congruency with "ideal" self-schemas, increased discrepancy with "addict" self-schemas, and generally more positive self-representations. In addition, "abstainers" reported reduced posttreatment craving in the presence of cocaine cues, but evidenced no change in physiological reactivity. Implications of these findings for research and treatment are discussed.
J Subst Abuse Treat
PMID:Changes concurrent with initiation of abstinence from cocaine abuse. 830 43

Methadone maintenance patients (N = 217) were administered a computerized screening version of the National Institute for Mental Health (NIMH) Diagnostic Interview Schedule (DIS), the Beck Depression Inventory (BDI) and the Addiction Severity Index (ASI) 2-4 weeks after treatment entry. Few differences were found between African-American, Hispanic, and Caucasian subjects. Only 1.7% of the patients met a lifetime diagnosis of major depressive disorder, and 1.4% qualified for a current diagnosis major depressive disorder. In contrast, 35.8% of the patients reported moderate to serious depression on the BDI during the previous week, and 19.3% reported serious depression during the previous month on the ASI (38.7% lifetime depression). Because moderate correlations were found between the DIS, the BDI, and the ASI measures of depression, there is some indication that they were tapping a similar construct. Therefore the lower rates of depression found with the DIS are probably attributable to its more stringent definition of depression. The findings tend to confirm previous literature indicating that the DIS, as contrasted with other structured psychiatric interviews, underestimates depression.
J Subst Abuse 1993
PMID:Conflicting measurements of depression in a substance abuse population. 832 85

Domestic violence is a widespread problem in our society that has not been extensively studied using psychological assessment tools. In this investigation, the psychological functioning of battered women in transition was examined through the use of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Thirty-one women (M age = 30 years, M education = 11.5 years) were evaluated as residents in a confidential shelter operated by Women Against Abuse. All subjects were asked to complete the MMPI-2 as well as information on their history of length, severity, and types of abuse (i.e., physical and/or psychological). Results indicated elevated MMPI-2 profiles in 90% of the subjects with the most frequent code type being a combination of Scales F, 4, 6, and 8. Scales 2 and 7, which are often associated with depression, anxiety, and other forms of subjective distress, were not consistently elevated. Supplementary MMPI-2 scales revealed elevations on scales MAC-R, Mt, PK, and PS. Regression analysis indicated significant relationships between length and severity of psychological forms of abuse and overall levels of psychological distress (i.e., F scale and average clinical T-score). Age and physical forms of abuse were not related to MMPI indices of psychological disturbance. Theoretical issues of domestic violence, intervention strategies with battered women, and the dangers of misdiagnosis are discussed.
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PMID:MMPI-2 profiles of battered women in transition. 843 60

Opiate users seeking treatment during similar time periods in 1986 (n = 60) and 1988 (n = 82) did not differ significantly with regard to demographic factors, length of addiction, use of cocaine, history of alcohol problems, or indices of depression. In 1988, however, users reported significantly lower rates of current intravenous drug use than was reported in 1986: 39% in 1988, compared to 14% in 1986, reported not currently using IV (chi 2(1, N = 142) = 11.302, p < .001). For the combined periods, current IV users (n = 102) did not differ significantly from those who were not currently using IV (n = 40) with regard to demographic factors, size of habit, history of alcohol problems, or indices of depression. Current IV users had used opiates longer (mean 11.3 years versus 8.4 years; t(1, 65) = 2.20, p < .03), and there was a trend for cocaine use to be associated with current IV administration. For the smaller subset of those who survived waiting lists of between 1 to 4 months from the time of intake to program admission and physical examination (n = 81), 35% (6/17) of those who were not IV drug users at the time of clinic intake reported resuming or initiating IV drug use by the time of program admission. The validity of self-reports of not using IV at the time of program admission was assessed by comparison of self-report with findings of track marks on physical examination: inconsistencies were detected in 11% (1/9) of those whose self-reports indicated no current IV use.
J Subst Abuse Treat
PMID:Decline in intravenous drug use among treatment-seeking opiate users. 845 May 73

Literature on cocaine-dependent patients studied through psychological testing remains limited, while there is much on assessment of alcoholics. This study replicated previous evaluation of cocaine-dependent patients, now compared with a group of alcoholics. Seventy-eight male and 21 female cocaine dependents and 70 male and 24 female alcoholics, hospitalized in a dual diagnosis program, were administered the MMPI, Millon Clinical Multiaxial Inventory-II (MCMI-II), Rorschach, Beck Depression Inventory, and Shipley Institute of Living Scale, after a 2-week stabilization period. Test data were statistically analyzed and compared along with demographic information. Cocaine-addicted subjects were younger, more often single and Afro-American, of lower socioeconomic status, less educated, and had slightly lower intellectual functioning and lesser family occurrence of addiction than alcoholics. Patients dependent on cocaine showed statistically more distress and psychopathology. Both groups demonstrated a high occurrence of personality disorders, but with different patterns of diagnoses. Implications for further research and treatment are discussed.
J Subst Abuse Treat
PMID:Psychopathology in alcohol- and cocaine-dependent patients: a comparison of findings from psychological testing. 845 May 74

Dimenhydrinate may be a relatively common yet unrecognized substance of abuse among adolescents. Abuse of this drug may present as a psychiatric syndrome, particularly depression. Three cases are presented which illustrate this relationship. A review of the literature is presented and suggestions are made for identifying adolescents who abuse dimenhydrinate.
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PMID:Dimenhydrinate abuse among adolescents. 846 36

In the course of a 10-year longitudinal investigation of young Swiss adults, childhood sexual abuse was assessed at the age of 30 years. It was reported by 11.5% of women and by 3.5% of men; 56% of the females had been abused by relatives (none of the males), 20% by fathers. Abuse cases tended to be more depressed and anxious; they reported more suicide attempts and more sexual problems than controls and also slightly more psychiatric symptoms and neuroticism. Childhood familial risk factors were more frequent for abuse cases than for controls. Depression at adult age was more strongly connected with early familial risk factors than with early sexual abuse.
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PMID:The Zurich Study. XVII. Sexual abuse in childhood. Frequency and relevance for adult morbidity data of a longitudinal epidemiological study. 849 99


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