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NIDA Science & Practice Perspectives

Volume 2, Number 1 - September 2003

From the Director

Blending Practice and Research: A Potent Catalyst for Progress
[PDF - 136K]

Nora D. Volkow, M.D.

From the Editor

Innovation, Adaptation, Integration, Conversation
[PDF - 112K]
David Anderson

Research Reviews

Integrating Substance Abuse Treatment and Criminal Justice Supervision
[PDF - 248K]
Douglas B. Marlowe, J.D., Ph.D.
Proponents of a pure public safety perspective on the drug problem hold that drug-involved offenders require consistent and intensive supervision by criminal justice authorities in order to stay off drugs and out of trouble. In contrast, proponents of a thoroughgoing public health perspective commonly argue that clients perform better if they are left alone to develop an effective therapeutic alliance with counselors. Both may be correct, but with respect to different groups of offenders. One approach has shown consistent promise for reducing drug use and criminal recidivism: an integrated public health-public safety strategy that combines community-based drug abuse treatment with ongoing criminal justice supervision. This article presents promising findings from programs implementing this strategy and discusses best treatment practices to meet the needs of both low-risk and high-risk clients.

Treating Adolescents for Substance Abuse and Comorbid Psychiatric Disorders
[PDF - 248K]
Paula D. Riggs, M.D.
Recent research has identified a cluster of standardized approaches that effectively treat adolescents with substance abuse disorders. Many of these approaches share elements that may be adopted to improve outcomes in substance treatment programs. In adolescents, treatment goals should be informed by a comprehensive assessment that includes the adolescent patient’s developmental history and evaluation of psychiatric comorbidity. Treatment for behavioral, psychosocial, and psychiatric problems should be integrated with substance abuse interventions. The author describes practical clinical guidelines, grounded in current research, for providing integrated treatment services. Special emphasis is given to strategies for integrating the treatment of comorbid psychiatric disorders with substance use disorders in adolescents.

Clinical Perspectives

Targeting Nicotine Addiction in a Substance Abuse Program
[PDF - 228K]
James R. Sharp, Ph.D., Steven Schwartz, Ph.D. (Cand.) CASAC, Thomas Nightingale, B.S., CASAC, and Steven Novak, M.D.
The potential benefits of addressing nicotine addiction as part of substance dependency treatment may include improved response to interventions for other addictions and, over the long term, reduced tobacco-related morbidity and mortality. The authors recount the experiences of three inpatient programs that instituted nicotine addiction interventions and a tobacco-free policy for both facilities and patients. After making adjustments to counter temporary adverse effects of the policy, two of the programs are achieving higher overall treatment completion rates than prior to implementation. Outstanding research issues include quantifying the costs and benefits of the antinicotine interventions, determining the long-term impact of tobacco-free treatment, and tailoring treatment to various patient groups.

12-Step Participation as a Pathway to Recovery: The Maryhaven Experience and Implications for Treatment and Research
[PDF - 236K]
Gregory S. Brigham, Ph.D.
Maryhaven, a comprehensive, community-based drug abuse treatment facility, combines a core commitment to 12-step principles and practices with the use of scientifically derived treatment interventions. Treatment goals at Maryhaven include abstinence from substance abuse, patient engagement and progress in 12-step activities, and strong patient affiliation with 12-step organizations within the community. The author discusses the reasons why Maryhaven takes this approach, describes the program's use of empirically derived treatment tools to further 12-step objectives, argues that there are natural affinities between 12- step and some empirical treatment tools such as the Stages of Change model, and suggests research projects that he believes can improve treatment and illuminate the mechanisms by which 12-step activities help patients overcome addiction.
[Links to Selected References from this Article]

Science and Practice in Action

Fishbowls and Candy Bars: Using Low-Cost Incentives To Increase Treatment Retention
[PDF - 236K]
Nancy M. Petry, Ph.D., and Michael J. Bohn, M.D.
Contingency management approaches that reward patients for meeting their drug abuse treatment objectives have demonstrated effectiveness in cocaine dependence clinical trials nationwide. The cost of such programs, however, was considered prohibitive for most communitybased treatment providers. In this article, Drs. Nancy Petry, a researcher, and Michael Bohn, Medical Director of a community substance abuse treatment program, discuss researching and implementing interventions designed to produce the benefits of contingency management at a fraction of the cost.

Authors and Respondents

This Issue's Authors
[PDF - 108K]

Graphic Evidence

Brain Activity During Cue-Induced Craving
[PDF - 800K]

Continuing Education Quiz for Counselors

You can earn two nationally certified continuing education (CE) hours by reading the indicated articles and completing this multiple-choice quiz. This is an open-book exam. Complete the quiz by circling one or more ofthe multiple-choice answers. Be sure to answer all questions; unanswered questions will be scored as incorrect. You must score at least 70 percent to earn CE hours.
[PDF - 132K]

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