Impact of psychosocial treatments on associated problems of cocaine-dependent patients.

A previous report from the National Institute on Drug Abuse Collaborative Cocaine Treatment Study (P. Crits-Christoph et al., 1999) found relatively superior cocaine and drug use outcomes for individual drug counseling plus group drug counseling compared with other treatments. Using data from that study, the authors examined the relative efficacy of 4 treatments for cocaine dependence on psychosocial and other addiction-associated problems. The 487 patients were randomly assigned to 6 months of treatment with cognitive therapy, supportive-expressive therapy, or individual drug counseling (each with additional group drug counseling), or to group drug counseling alone. Assessments were made at baseline and monthly for 6 months during the acute treatment phase, with follow-up visits at 9 and 12 months. No significant differences between treatments were found on measures of psychiatric symptoms, employment, medical, legal, familysocial, interpersonal, or alcohol use problems. The authors concluded that the superiority of individual drug counseling in modifying cocaine use does not extend broadly to other addiction-associated problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mediators of outcome of psychosocial treatments for cocaine dependence.

This study examined endorsement of 12-step philosophy and engagement in recommended 12-step activities as a mediator of the outcomes of individual plus group counseling for cocaine dependence. Assessments of drug use outcomes and the mediator were made at baseline and monthly for 6 months. Engagement in recommended 12-step activities was found to be a partial statistical mediator of drug use outcomes of individual (plus group) drug counseling, but no evidence for change in the mediator preceding change in drug use was found. In addition, a measure of beliefs about addiction developed to test mediation of outcome of cognitive therapy was found to correlate moderately with drug use outcomes in both cognitive therapy and individual drug counseling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cost-benefit and cost-effectiveness analyses of behavioral marital therapy as an addition to outpatient alcoholism treatment

Thirty-six newly abstinent married male alcoholics, who had recently begun outpatient individual alcoholism counseling, were randomly assigned to a no-marital-therapy control group or to 10 weekly sessions of a behavioral marital therapy (BMT) or an interactional couples group. The cost-benefit analysis of BMT plus individual alcoholism counseling showed (a) decreases in health care and legal costs in the 2 years after as compared to the year before treatment, (b) a positive cost offset, and (c) a benefit-to-cost ratio greater than 1 indicating that health and legal system cost savings (i.e., benefits) exceeded the cost of delivering the BMT treatment. None of the positive cost-benefit results observed for BMT were true for participants given interactional couples therapy plus individual alcoholism counseling for which posttreatment utilization costs increased. Thus, adding BMT to individual alcoholism counseling produced a positive cost benefit, whereas the addition of interactional couples therapy did not. Individual counseling both alone and with BMT added showed substantial and significant cost savings from reduced utilization that substantially and significantly exceeded the cost of delivering the treatment; and the two treatments did not differ significantly on these cost savings and cost offsets. Individual counseling alone did have a significantly more positive benefit-to-cost ratio than BMT plus individual counseling due to the lower cost of delivering the individual counseling which was about half the cost of delivering BMT plus individual counseling. Cost-effectiveness analyses indicated that BMT plus individual counseling was less cost effective than individual counseling alone and modestly more cost effective than interactional therapy in producing abstinence from drinking. When marital adjustment outcomes were considered, the three treatments were equally cost effective except during the active treatment phase when BMT was more cost effective than interactional couples therapy. Study limitations are discussed.     

Outcome, attrition, and family-couples treatment for drug abuse: a meta-analysis and review of the controlled, comparative studies

This review synthesizes drug abuse outcome studies that included a family-couples therapy treatment condition. The meta-analytic evidence, across 1,571 cases involving an estimated 3,500 patients and family members, favors family therapy over (a) individual counseling or therapy, (b) peer group therapy, and (c) family psychoeducation. Family therapy is as effective for adults as for adolescents and appears to be a cost-effective adjunct to methadone maintenance. Because family therapy frequently had higher treatment retention rates than did nonfamily therapy modalities, it was modestly penalized in studies that excluded treatment dropouts from their analyses, as family therapy apparently had retained a higher proportion of poorer prognosis cases. Re-analysis, with dropouts regarded as failures, generally offset this artifact. Two statistical effect size measures to contend with attrition (dropout d and total attrition d) are offered for future researchers and policy makers.     

Strike while the iron is hot: Can stepped-care treatments resurrect relapsing smokers?

The efficacies of 2 group counseling step-up treatments for smoking cessation, cognitive-behavioral/skill training therapy (CBT) and motivational interviewing/supportive (MIS) therapy, were compared with brief intervention (BI) treatment in a sample of 677 smokers. Differential efficacy of the 2 step-up treatments was also tested in smokers at low and high risk for relapse (no smoking vs. any smoking during the first postquit week, respectively). All participants received 8 weeks of nicotine patch therapy. BI consisted of 3 brief individual cessation counseling sessions; CBT and MIS participants received BI treatment and 6 group counseling sessions. Neither CBT nor MIS treatment improved long-term abstinence rates relative to BI. Limited support was found for the hypothesis that high-risk smokers would benefit more from MIS than CBT. Other hypotheses were not supported. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outcome, attrition, and family–couples treatment for drug abuse: A meta-analysis and review of the controlled, comparative studies.

This review synthesizes drug abuse outcome studies that included a family–couples therapy treatment condition. The meta-analytic evidence, across 1,571 cases involving an estimated 3,500 patients and family members, favors family therapy over (a) individual counseling or therapy, (b) peer group therapy, and (c) family psychoeducation. Family therapy is as effective for adults as for adolescents and appears to be a cost-effective adjunct to methadone maintenance. Because family therapy frequently had higher treatment retention rates than did nonfamily therapy modalities, it was modestly penalized in studies that excluded treatment dropouts from their analyses, as family therapy apparently had retained a higher proportion of poorer prognosis cases. Re-analysis, with dropouts regarded as failures, generally offset this artifact. Two statistical effect size measures to contend with attrition (dropout d and total attrition d) are offered for future researchers and policy makers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist Satisfaction With Four Manual-Based Treatments on a National Multisite Trial: An Exploratory Study.

Ratings by 44 therapists in 4 modalities (cognitive, supportive-expressive, individual drug counseling, and group drug counseling) were obtained during one of the largest outcome trials ever conducted, the National Collaborative Cocaine Treatment Study. Views of the treatments, desired changes, and influences on implementation were studied. Therapists were highly positive about the treatments. However, their likelihood of using them in the future without modification was low, and they viewed them as too short. Supervision was perceived as more important than manuals and taping of sessions as more important than adherence scales. It took therapists an average of 8 months to feel comfortable with the treatments. New learning was therapists' primary motivation, more than extrinsic factors such as pay. Supportive-expressive therapists reported the most negative views, among modalities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of self-limited, externally-limited and unlimited counseling or therapy.

Randomly assigned 38 students who sought counseling at a university's counseling service to 1 of 3 treatment conditions: self-limited, externally limited, and unlimited. Those in the self-limited group heard a taped rationale concerning that condition and set their own upper limit, while those in the externally limited group heard a rationale and had a limit imposed. Records kept on missed sessions and dropouts favored the time-limited groups, while pre- and posttreatment changes on the Psychological Screening Inventory favored the unlimited group. Clients and therapists rated all groups as equally effective. Similarity to other findings and implications for future research are discussed. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of three methods of reducing test anxiety: Systematic desensitization, implosive therapy, and study counseling.

Administered the Alpert-Haber Achievement Anxiety Test to 39 undergraduates. Finger sweat prints were also included as anxiety measures. Ss were assigned to 4 groups: systematic desensitization, implosive therapy, study counseling, and a no-treatment control group. Groups met for 4 1-hr sessions for 2 wks. Results suggest that systematic desensitization is more effective in reducing debilitating anxiety than either implosive therapy or study counseling and that implosive therapy is more effective than study counseling, which was not significantly different than no treatment. No significant differences between treatments were found on the physiological measure of anxiety, GPAs (compared before and after treatment), or facilitating anxiety. Findings support previous studies comparing desensitization and study counseling. (18 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spirituality and religion in group counseling: A literature review with practice guidelines.

There has been increased discussion of the need to attend to clients' spirituality and religion as a part of the counseling process, but much of the literature to date has focused on individual counseling. How do the research and resulting practice implications apply to group counseling? This article provides a rationale for attending to spirituality and religion in counseling, explores the opportunities and barriers in attending to spirituality and religion in group counseling, and reviews the literature on the growing number of group interventions with a spiritual or religious focus. The article ends with specific guidelines for when and how to incorporate spirituality and religion into group counseling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multimodal treatment package for substance abuse treatment programs.

Describes a multimodal treatment design for a short-term, residential, hospital-based program for drug abusers. Each patient is expected to attend all program services with the intent that one or several will provide the corrective emotional experience facilitating change. Services included medical care, individual counseling/psychotherapy, group counseling, health education seminars, milieu/recreational therapy, Narcotics Anonymous meetings, linkage with aftercare components, and ancillary services (vocational rehabilitation, court liaison, and 90-day follow-up). Psychology interns and students are utilized. Results of internal follow-up show that 40% of Ss admitted over 3 yrs stated they were drug-free at 90 days and 1.5 yrs. (3 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drug-induced uveitis

The structural approach to family therapy offers a useful perspective to the nurse therapist working with families with various cultural backgrounds. Asian and Hispanic families are examined to illustrate using Minuchin's approach to family counseling. The rationale for the structural approach is explored, and specific therapeutic techniques for practice are described. Nurses who work with culturally diverse families might profit by using this approach.     

Narcotics addiction treatment: behavioral methods concurrent with methadone maintenance

Methadone maintenance patients were assigned among four treatment cells involving contingency management, emotionally-based behavior therapy, a combination of these, or a control condition receiving counseling but no behavioral treatment. With 60 patients who remained in treatment at least 6 months, treatment outcomes were compared using objective measures: hours employed, urinalysis results, and counseling participation. No significant differences were found between modalities. Case studies suggested that under appropriate conditions, contingency management might reduce illicit drug use. It is suggested that focused experimental studies may be more productive than broad clinical outcome evaluations.     

A group counseling emphasis at a university counseling center.

Describes a service delivery system with a group personal counseling emphasis, based on the authors' 2 yrs of experience at a university counseling center. The local background and rationale for this system are discussed, and the practical logistics, the operational policies, and the group ground rules are presented. Utilization data are summarized: 36% of all clients and 88% of clients with 8 or more sessions were group members; groups typically grew to 9 clients and had 60% attendance. Results for a self-report outcome survey of 128 students are exemplified by the 95.1% who reported some level of improvement and the 92.2% who rated their psychologist "very" to "exceptionally effective." (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expectations about counseling in relation to acculturation in Mexican-American and Anglo-American student samples.

A rationale for the role of client expectations in counseling theory and practice with Mexican Americans is set forth. The Expectations About Counseling-Brief form questionnaire (K. Washington and H. E. Tinsley, 1982) and the Acculturation Rating Scale for Mexican Americans (I. Cuellar et al; see record 1981-27035-001) were administered to 213 Mexican-American and 137 Anglo-American subjects. Data from questionnaires were augmented through semi-structured interviews with each group. Levels of acculturation, gender, and previous experience with counseling were evaluated for their influence on expressed expectations in each ethnic group. Although no significant group effects were noted, expectations did significantly vary with acculturation categories. Implications of these results for counseling theory and practice with Mexican Americans are briefly discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison between low-magnitude voucher and buprenorphine medication contingencies in promoting abstinence from opioids and cocaine.

This study compared the relative efficacy of low-magnitude, contingent monetary vouchers, contingent buprenorphine medication, and standard counseling in promoting abstinence from illicit opioids and cocaine among opioid-dependent adults. Following an 8-week baseline period during which participants received buprenorphine maintenance treatment with no contingencies in place, 60 participants were randomly assigned to one of 3 treatment groups for 12 weeks: (a) Participants in the voucher group earned vouchers for each opioid- and cocaine-negative urine sample, in accordance with an escalating schedule. Continuous abstinence resulted in voucher earnings equivalent to a total of $269, which participants could exchange for material reinforcers of their choice. (b) Participants in the medication contingency group received half their scheduled buprenorphine dose for clinic attendance and the other half for remaining abstinent from opiates and cocaine. Thus, they received only half of their scheduled dose on submission of an opioid- and/or cocaine-positive urine sample. (c) Participants in standard treatment did not receive programmed consequences contingent on urinalysis results. All participants were maintained with buprenorphine according to a 3-times-per-week dosing regimen and participated in behavioral drug counseling. Retention rate did not significantly differ across the groups; however, participants in the medication contingency group achieved significantly more weeks of continuous abstinence from opiates and cocaine compared with participants in the voucher group (Ms = 5.95 and 2.90, respectively). Results suggest that the use of medication-based contingencies in combination with behavioral therapy in promoting drug abstinence may have clinical utility. Limitations of the study are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic alliance as a predictor of outcome and retention in the National Institute on Drug Abuse Collaborative Cocaine Treatment Study.

The authors examined the relation between therapeutic alliance, retention, and outcome for 308 cocaine-dependent outpatients participating in the National Institute on Drug Abuse Collaborative Cocaine Treatment Study. High levels of alliance were observed in supportive–expressive therapy (SE), cognitive therapy (CT), and individual drug counseling (IDC), and alliance levels increased slightly but significantly from Session 2 to Session 5 in all groups. In contrast to other studies, alliance was not a significant predictor of drug outcome. However, alliance did predict patient retention differentially across the 3 treatments. In SE and IDC, either higher levels of alliance were associated with increased retention or no relationship between alliance and retention was found, depending on the time alliance was measured. In CT, higher levels of alliance were associated with decreased retention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The striatum in the system of the central mechanisms of biorhythm control

BACKGROUND: This study was undertaken to assess the safety and efficacy of a treatment involving brief counseling and the nicotine patch among hospital inpatients and to identify variables associated with long-term smoking cessation following hospitalization. METHODS: One hundred eighty-five patients were randomly assigned to one of three smoking cessation interventions: (1) A Minimal Care (MC) condition, consisting of a brief physician-delivered motivational message to stop smoking, (2) a Counseling + Active Nicotine Patch (CAP) condition in which patients received the motivational message, a 6-week supply of nicotine patches, and extended bedside and telephone counseling, and (3) a Counseling + Placebo Patch (CPP) condition identical to the CAP condition except the supplied patches contained no nicotine. RESULTS: At 6-month follow-up, abstinence rates for the three treatments were 4.9, 6.5, and 9.7% for the MC, CPP, and CAP treatments, respectively. These differences were not statistically significant. Patients admitted for respiratory disease were more likely to quit than patients with any other diagnosis. The nicotine patch was well tolerated by hospital inpatients. CONCLUSIONS: The initiation of nicotine patch therapy during hospitalization appears to be safe when used among patients carrying a wide range of diagnoses. Our study provided no evidence of the superiority of nicotine patches versus placebo, but this does not preclude the possibility that future research using larger samples might detect differences between patch groups. Hospital interventions for smoking cessation may be most effective among patients hospitalized for a smoking-related illness such as respiratory disease.