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Director's Report to the National Advisory Council on Drug Abuse - February, 2006

Research Findings - Research on Behavioral and Combined Treatments for Drug Abuse

Cocaine Using Parents With and Without Custody Have Different Problems Upon Treatment Entry

Nancy Petry and colleagues at University of Connecticut School of Medicine examined demographic variables, Addiction Severity Index Scores, and Brief Symptoms Inventory scores of cocaine-using parents entering treatment. The 93 parents with custody showed more severe cocaine and alcohol problems than the 125 without custody. Parents without custody showed more psychiatric distress, employment and legal problems and a greater history of alcohol problems. The results suggest treatment needs for parents and their families may differ according to parental custody. Lewis, M.W. and Petry, N.M. American Journal of Addiction, pp. 403-415, October 2005.

Gamblers with Antisocial Personality Disorder (ASPD) Exhibit More Drug Problems

Nancy Petry and colleagues at University of Connecticut School of Medicine examined problems of 237 compulsive gamblers entering a treatment program and found that approximately 16.5% of participants met diagnostic criteria for ASPD. Male gender, history of illicit substance use, Addiction Severity Index Medical composite score, and the number of criteria for compulsive gambling diagnosis all were positive predictors of Antisocial Personality Disorder. These individuals were more likely to have had a history of substance abuse treatment and to have used a wider variety of substances at higher lifetime rates. The results add to the body of literature supporting a subtype of gambler characterized by high levels of other risk taking and illegal behavior such as substance abuse. Pietrzak R.H. and Petry N.M. Addiction, pp. 1183-1193, August 2005.

Therapist Skillfulness Predicts Patient Involvement in Motivational Interviewing

William Miller and colleagues at the University of New Mexico examined whether therapist skillfulness at conveying egalitarianism, empathy, genuineness, and warmth, all components of the philosophy or spirit of Motivational Interviewing (MI), were as important as engaging in specific MI counseling techniques such as asking open ended questions, for predicting client engagement and cooperation. Tapes of 103 sessions of motivational interviewing provided by trained therapists were coded and rated for both skillfulness and conformance to MI technique. Results showed that skillfulness rather than adherence to technique was more important. Additionally, therapists were able to engage in behaviors that are typically considered incompatible with MI, such as advice giving, provided they exhibited high levels of skillfulness with regards to conveying the MI spirit. This study suggests MI training programs should emphasize and therapist skills for conveying MI spirit before teaching MI techniques. It also suggests that a broader array of techniques may be able to be incorporated into this treatment approach provided they convey genuineness, empathy and other indicators of a warm collaboration. This work is significant because it underscores a potential reason why some clinicians might not produce good outcomes in motivational interviewing sessions and suggests further ways to improve therapist training. Moyers, T.B., Miller, W.R. and Hendrickson, S.M. Journal of Consulting and Clinical Psychology, pp. 590-598, August 2005.

After 30 Days of Abstinence, Cocaine Users Still Prefer Quicker Rewards

Steve Higgins and colleagues at the University of Vermont examined the phenomenon of delay discounting, which is the tendency of people to prefer smaller rewards available more quickly to larger rewards available farther in the future. High rates of discounting are thought to represent an impulsive behavioral style. Twenty-one cocaine users in treatment reporting no cocaine use in the previous 30 days, 21 cocaine users reporting at least one day of use in the past thirty days and 21 non-drug using controls were enrolled. Each participant was asked to equate $1000.00 at seven different future times to ranging amounts of money given immediately and the slope of these choices were plotted on a discounting curve. Controls consistently discounted the value of money given sooner less than both groups of cocaine users. This suggests that cocaine users have higher rates of impulsivity than non-users. Additionally, whereas studies of opioid users have shown that abstinence impacts discounting rates, this study did not show a difference between cocaine users with recent use and cocaine users with over a month of abstinence. The failure to find a change in discounting results associated with abstinence may indicate that cocaine users unlike opioid users retain an impulsive style with regards to monetary choices even after abstinence has been established. Heil, S.H., Johnson, M.W., Higgins, S.T. and Bickel, W.K. Addictive Behaviors, pp. (Epub), October 2005.

Subjective and Physiological Responses to Smoking Cues in Smokers with Schizophrenia

Dr. Tidey and colleagues at Brown Medical School conducted a study to test the effects of smoking cues on the urge to smoke and on negative affect among people with schizophrenia. They tested 25 outpatients' reactions to both neutral and smoking-related objects, just after smoking and after 2 hours of abstaining, and found that exposure to smoking cues consistently increased smoking urge levels, despite differences in medications and symptoms. Abstaining from smoking did not appear to alter these effects. The findings suggest that their model could be used to screen interventions that might be used to decrease reactions or exposure to smoking stimuli. The model might also be useful in investigating the neurobiological underpinnings of smoking urges among those with schizophrenia. Tidey, J.W., Rohsenow, D.J., Kaplan, G.B. and Swift, R.M. Nicotine and Tobacco, 7, pp. 421-429, 2005.

Preliminary Evidence of the Association between the History of Childhood Attention-Deficit/Hyperactivity Disorder and Smoking Treatment Failure

Dr. Humfleet and colleagues at the University of California, San Francisco, conducted a study to examine abstinence rates among 428 adult smokers participating in two randomized controlled trials. Participants were treated with nicotine replacement, antidepressants, and psychological counseling. Childhood ADHD was assessed retrospectively by diagnostic interview. A history of childhood ADHD was diagnosed in 11% of the smokers. More smokers with a diagnosis of childhood ADHD relapsed than those with no such history, and they relapsed sooner. Only 1 of 47 smokers with childhood ADHD was still abstinent by week 52, compared with 18% of those without. Additionally, those with childhood ADHD relapsed after an average of 159 days, compared with 294 days for others. These results highlight the need to further evaluate smoking treatments for this high-risk group. Humfleet, G.L., Prochaska, J.J., Mengis, M., Cullen , J., Munoz, R., Reus, V. and Hall, S. Nicotine Tob Res., 7(3), pp. 453-460, 2005.

Smoking Cessation Research via the Internet: A Feasibility Study

This study demonstrated the feasibility of conducting a brief, self-help smoking cessation intervention over the Internet, using a one-group, pre-post design. The website was constructed to recruit participants, obtain informed consent, collect assessment data, provide a brief educational intervention and obtain 1-month follow-up data, all without human contact. Of the 538 participants who signed the consent form, 230 returned to complete the 1-month follow up assessment. Among these individuals, 92 made a serious attempt to quit smoking and 19 reported 7-day abstinence. Intention to quit smoking increased by 67% from baseline while 75% reported that they found the site helpful to quitting goals. The findings suggest that the web is a practical environment for delivering and evaluating smoking cessation interventions. More research is needed on Internet interventions, particularly on procedures to retain users for treatment and follow-up assessment. Internet interventions have the ability to treat large segments of the smoking population in a cost-effective manner. Stoddard, J.L., Delucchi, K.L., Munoz, R.F., Collins, N.M., Perez Stable, E.J., Auguston, E. and Lenert, L.L. Journal of Health Communication, 10, pp. 27-41, 2005.

Acute Nicotine Withdrawal Symptoms and Anxious Responding to Bodily Sensations

Dr. Zvolensky and colleagues from the University of Vermont conducted this study to determine whether acute nicotine withdrawal symptoms predict anxious responding to a biological challenge, relative to other established factors, like negative affectivity, anxiety sensitivity, and nicotine dependence. The sample consisted of 90 regular smokers who were in a state of relatively acute nicotine deprivation (approximately 120 min). Subjects were assessed for panic attack symptoms and self-reported anxiety before and after a 3-min voluntary hyperventilation challenge. Findings showed that acute nicotine withdrawal symptoms assessed pre-challenge predicted the post-challenge intensity of panic sensations. Moreover, the effect cannot be attributed to other theoretically relevant factors. This study is important because although previous work has found associations between panic and smoking, little research has investigated potential mechanisms by which smoking may contribute to panic problems. Zvolensky, M.J., Feldner, M.T., Leen-Feldner, E.W., Gibson, L.E., Abrams, K. and Gregor, K. Behaviour Research and Therapy, 43, pp. 1683-1700, 2005.

Cuban American Juvenile Offenders who Abuse Drugs Report Higher Rates of Some HIV Risk Behaviors than do Comparable African American Teens

Drs. Jessy Devieux and colleagues at Florida International University conducted a detailed assessment of HIV risk behaviors in a sub-sample of adolescents participating in an HIV risk reduction intervention. Of the 137 participants in the interview assessment, 81 were African American teens and 57 were Cuban American teens, both with an average age of about 15.5 years old. Cuban American teens reported more unprotected sex acts and more anal sex acts in the 6 months prior to the interview than did African American teens. The groups were similar on the total number of sexual partners and sex acts reported. Regarding drug use, a greater proportion of Cuban American teens reported using drugs in the six months prior than did African American teens, and Cuban American teens reported engaging in unprotected sex while using drugs than did African American teens. The authors speculate that higher acculturation of Cuban American teens, and accompanying family conflict, may account for the relatively more risky behavior among Cuban American teens. More research is needed to clarify the processes leading teens of different backgrounds to initiate and maintain risky behaviors, and to identify the most effective ways to intervene to reduce risk. Devieux, J. G., Malow, R. M., Ergon-Perez, E., Samuels, D., Rojas, P., Kushal, S. R., Jean-Gilles, M. JSWPA, pp. 69-83, 2005.

Efficacy of Dose and Contingency Management Procedures in LAAM Maintained Cocaine-Dependent Patients

Dr. Oliveto and colleagues at Yale University randomly assigned opioid and cocaine dependent patients (n=140) to one of the following in a 12 week clinical trial: 1) LAAM (30,30,39mg/MWF) with contingency management; 2) LAAM (30,30,39mg/MWF) without contingency management; 3) LAAM (100, 100, 130mg/MWF) with contingency management; and 4) LAAM (100,100,130mg/MWF) without contingency management. Urine samples were collected 3 times per week. In contingency management, each urine negative for both opioids and cocaine resulted in a voucher worth a certain monetary value that increased for consecutively drug free urines. Vouchers were exchanged for mutually agreed upon goods and services. The groups did not differ on retention and baseline characteristics. Abstinence from both opioids and cocaine was greatest in the high dose LAAM plus contingency management group. However, contingency management procedures were not as effective in reducing cocaine use at the lower doses of LAAM. The results suggest than an efficacious maintenance dose may be necessary for contingencies to be effective in facilitating both opioid and cocaine abstinence in this dually dependent population. Oliveto, A., Poling, J., Sevarino, K.A., Gonsai, K.R., McCance-Katz, E.F., Stine, S.M., Kosten, T.R. Drug and Alcohol Dependence, 79(2), pp. 157-165, 2005.

Moderators of Effects of Motivational Enhancements to Cognitive Behavioral Therapy

Dr. Rosenblum and colleagues at the Institute for Treatment and Services Research, National Development and Research Institutes, Inc, in New York, conducted a study in which patient treatment matching hypotheses were tested for substance users randomly assigned to a group cognitive behavioral therapy (CBT; n=114) or a group motivational intervention (GMI; n=116). Treatment was scheduled twice weekly for 10 weeks. Using a patient attribute by treatment interaction design with a 15 week follow up, the study predicted that alexithymia, antisocial personality disorder, and network support for alcohol and drug use would be associated with less substance use for CBT subjects, and that hostility and lower motivation would be associated with less substance use for GMI subjects. Three of the hypothesized moderators were empirically supported: alexithymia, network support for alcohol, and antisocial personality disorder. The results indicate the use of assessing specific patient attributes to better inform treatment recommendations. Rosenblum, A., Cleland, C., Magura, S., Mahmood, D., Kosanke, N. and Foote, J. American J. Drug and Alcohol Abuse. 31(1), pp. 35-38, 2005.

Methadone versus Buprenorphine with Contingency Management or Performance Feedback for Cocaine and Opioid Dependence

Dr. Schottenfeld and colleagues at Yale University evaluated the efficacy of methadone vs. buprenorphine with contingency management or performance feedback for patients dependent on opioids and cocaine. One hundred and sixty -two subjects were provided manual guided counseling and randomly assigned in a double blind design to receive daily sublingual buprenorphine (12-16mg) or methadone (65-85mg, p.o.) and to contingency management or performance feedback. Contingency management subjects received monetary vouchers for opioid and cocaine negative urine tests; voucher value escalated during the first 12 weeks for consecutive drug free tests and was reduced to a nominal value in weeks 12-24. Performance feedback subjects received slips of paper indicating the urine test results. Primary outcome measures were the maximum number of consecutive weeks abstinent from illicit opioids and cocaine and the proportion of drug free tests. The findings indicate that the methadone treatment subjects remained in treatment significantly longer and achieved significantly longer periods of sustained abstinence and a greater proportion of drug free urine tests, compared with subjects who received buprenorphine. Subjects receiving contingency management achieved significantly longer periods of abstinence and a greater proportion of drug free tests during the period of escalating voucher value, compared with those who received performance feedback, but there were no significant difference between groups in these variables during the entire 24 -week study. The results suggest that methadone may be superior to buprenorphine for maintenance treatment of patients with co-occurring opioid and cocaine dependence. Combining methadone or buprenorphine with contingency management improved treatment outcome. Schottenfeld, R.S., Chawarski, M.C., Pakes, J.R., Pantalon, M.V., Carroll, K.M. and Kosten, T.R. American J. Psychiatry; 162(2), pp. 340-349, 2005.

Computer-based Brief Motivational Intervention for Perinatal Drug Use in Primary Care

Computer based brief motivational interventions may be able to reach a high proportion of at risk-individuals and thus have potential for significant population impact. Dr. Ondersma and colleagues at Wayne State University conducted a series of studies to determine the feasibility of delivering a computer-based brief motivational intervention, the Motivation Enhancement System (MES) for perinatal drug use. Overall, the women rated the MES as highly acceptable and easy to use and reported significant increases in state motivation at post-intervention and at one month follow up. These preliminary results suggest the feasibility of this approach. Ondersma, S.J., Chase, S.K., Svikis, D.S. and Schuster, C.R. Journal of Substance Abuse Treatment 28, pp. 304-312, 2005.

Cocaine Dependence and PTSD: A Pilot Study of Symptom Interplay and Treatment Preferences

Cocaine dependence and posttraumatic stress disorder (PTSD) frequently co-occur; however, little is known about patients' perceptions of symptom connectedness and preferences for treatment. Dr. Sudie Back and colleagues at the Medical University of South Carolina, conducted a preliminary investigation of patients' perceptions of symptom interplay and their preferences regarding concurrent or sequential models of psychotherapy, therapy format, and treatment modalities. Participants were 23 individuals with comorbid cocaine dependence and PTSD. The majority (95.5%) reported a functional relationship between cocaine use and PTSD symptoms. Improvement in PTSD symptoms was typically (63.3%) associated with a decrease in cocaine use, and a worsening of PTSD symptoms was typically (86.4%) associated with an increase in cocaine use. In contrast, improvement/deterioration in cocaine use was not significantly related to subsequent improvement/deterioration in PTSD symptoms. This finding suggests that changes in PTSD symptoms may be an important risk factor to consider among individuals with cocaine dependence and PTSD. Approximately 41% preferred a concurrent model of therapy in which cocaine use and PTSD were treated simultaneously in therapy. The findings highlight the functional relationship between these two disorders and have direct implications for treatment interventions. Back, S.E., Brady, K.T., Jaanimagi, U. and Jackson, J.L. Addict Behavior, June 9, 2005 [Epub ahead of print].

Anxiety Disorders among Patients with Co-occurring Bipolar and Substance Use Disorders

Dr. Kolodziej and colleagues at Harvard and Boston University examined the prevalence and nature of anxiety disorder among treatment seeking patients diagnosed with current bipolar and substance use disorders, and investigated the association between anxiety disorders and substance use. Among 90 participants diagnosed with bipolar disorder I (n=75, 78%) or II (n=15, 22%), 43 (48%) had a lifetime anxiety disorder, with posttraumatic stress disorder (PTSD) occurring most frequently (n=21, 23%). They found that those with PTSD, but not with the other anxiety disorders assessed, began using drugs at an earlier age and had more lifetime substance use disorders, particularly cocaine and amphetamine use disorders, than those without PTSD. Most participants with PTSD were women, sexual abuse was the most frequently reported index trauma, and the mean age of the earliest index trauma occurred before the mean age of initiation of drug use. These findings highlight the heterogeneity of dually diagnosed patients, and the importance of further investigating the ramifications of a trauma history among those who are diagnosed with bipolar and substance use disorders. Kolodziej, M.E., Griffin, M.L., Najavits, L.M., Otto, M.W., Greenfield, S.F. and Weiss, R.D. Drug and Alcohol Dependence, 80(2), pp. 251-257, 2005.

Behavioral Treatment Approaches for Methamphetamine Dependence and HIV-Related Sexual Risk Behaviors Among Urban Gay and Bisexual Men

Dr. Shoptaw and colleagues evaluated the efficacy of four behavioral drug abuse treatments for reducing methamphetamine use and sexual risk behaviors in methamphetamine-dependent gay and bisexual men. Participants (N=162) were assigned to 16 weeks of one of four behavioral treatments: standard cognitive behavioral therapy (CBT), contingency management (CM), combined cognitive behavioral therapy and contingency management (CBT+CM) and a culturally tailored cognitive behavioral therapy (GCBT). CM and CBT+CM conditions were statistically better than CBT during treatment in retention, in longest period of consecutive urine samples negative for methamphetamine metabolites, and in the Treatment Effectiveness Score. GCBT significantly reduced unprotected receptive anal intercourse during the first four weeks of treatment. Between-group differences found during treatment, disappeared at follow-up with overall reductions in outcomes sustained to one-year. The authors conclude that among high-risk methamphetamine-dependent GBM, drug abuse treatments produced significant reductions in methamphetamine use and sexual risk behaviors. Drug abuse treatments merit consideration as a primary HIV prevention strategy for this population. Shoptaw, S., Reback C.J., Peck, J.A., Yang, X., Rotheram-Fuller, E., Larkins, S., Veniegas, R.C. Freese, T.E. and Hucks-Ortiz, C. Drug and Alcohol Dependence, 78(2), pp. 125-134, 2005.

Brief Motivational Intervention for Adolescent Smokers in Medical Settings

Investigators from Brown University conducted a study designed to determine the efficacy of two brief behavioral interventions for smoking cessation in adolescents treated in a hospital outpatient clinic or Emergency Department. Patients aged 14-19 years (N=85) were randomly assigned to receive either one session of motivational interviewing (MI) or standardized brief advice (BA) to quit smoking. Patients were proactively screened and recruited and not seeking treatment for smoking. Follow-up assessments were conducted at 1, 3, and 6 months post-intervention. Adolescents in both conditions reported smoking reductions at all three follow-ups. Those in the MI group also showed reduced cotinine levels at 3 months, unlike those in BA, and both groups showed reduced cotinine levels at 6 months. Overall, abstinence rates were low and did not differ between groups at 1 or 3 months. At 6 months, self-report data indicated that abstinence rates were significantly higher for the MI group than the BA group, but this difference was not confirmed biochemically. Groups did not differ in biochemically confirmed abstinence at any follow-up. The low rates of abstinence found are consistent with findings from other adolescent smoking cessation trials, which have generally effected only minimal change even among treatment-seeking adolescents. Colby, S.M., Monti, P.M., O'Leary Tevyaw, T. Barnett, N.P., Spirito, A., Rohsenow, D.J., Riggs, S. and Lewander, W. Addictive Behaviors, 30, pp. 865-874, 2005.

Smoking Stage of Change and Interest in an Emergency Department-based Intervention

This study sought to assess the prevalence and predictors of smoking stage of change and interest in an ED-initiated smoking intervention. Patients in an emergency department were interviewed immediately before discharge from the ED or transfer to an inpatient floor. Among those interviewed, 581 (40%) were current smokers, 117 (21%) were in precontemplation stage, 241 (43%) were in contemplation stage, and 197 (36%) were in preparation stage. Sixty-two percent endorsed at least "somewhat" agreement that smoking counseling should be provided in the ED, while nearly one half (49%) agreed to stay 15 extra minutes to do so. Fifty-nine percent of treating physicians/nurses screened patients for smoking status, however only 8% of patients reported receiving information about quitting. The findings indicate that most smokers have at least some desire to change and appear interested in ED smoking cessation counseling. Due to limited efforts in the ED, efforts may be better spent on counseling patients who are receptive and ready to change. Boudreaux, E.D., Baumann, B.M., Friedman, K. and Ziedonis, D.M. Acad Emerg Med, 12, pp. 211-218, 2005.

Intentions to Quit Smoking Change over Short Periods of Time

This study intended to assess the stability of intention to quit smoking over a 30-day period. One-hundred and fifteen US and Swedish smokers were randomized to complete Stage of Change (SOC) or ladder scales of intentions to quit at either 0, 7, 14, and 30 days or at 0 and 30 days in the absence of intervention. The results indicate that measures of intention to quit are often unstable over short periods of time. The results also indicate the four-assessment group had more progression in intention to quit than the two-assessment group, indicating that repeated measurement can influence intention outcomes. Hughes, J.R., Keely, J.P., Fagerstrom, K.O. and Callas, P.W. Addictive Behaviors, 30, pp. 653-662, 2005.

Distress Tolerance and Early Smoking Lapse

This paper discusses the theoretical and clinical implications of distress tolerance in smoking cessation. Whereas past work on smoking relapse has largely addressed the role of withdrawal symptoms and negative affect, the model presented by Brown et al. emphasizes that how one reacts to the discomfort of nicotine withdrawal is a more promising avenue of investigation. Development of a specialized and novel behavioral distress tolerance treatment for early smoking lapsers is proposed. Brown, R.A., Lejuez, C.W., Kahler, C.W., Strong, D.R., and Zvolensky, M.J. Clin Psychol Rev, 6, pp. 713-733, 2005.

The Effects of a Prison Smoking Ban on Smoking Behavior and Withdrawal Symptoms

This study investigated symptoms of distress and nicotine dependence as predictors of nicotine withdrawal symptoms among 188 incarcerated male smokers during a mandated smoking ban. Participants were assessed at three time periods: baseline, 4 days after the smoking ban, and 1 month after the smoking ban. Most smokers (76%) continued to smoke following the smoking ban. Smokers after the ban were more nicotine dependent and reported more withdrawal symptoms than participants that quit. An interaction was found such that distressed smokers had the highest level of nicotine withdrawal. The authors surmise that the low compliance with the smoking ban was due to low motivation to enforce the ban on the part of prison employees, since they were affected by the ban as well. These results have implications for how smoking bans are instituted in prison settings. Cropsey, K.L. and Kristeller, J.L. Addictive Behaviors, 30, pp. 589-594, 2005.

Acceptance of Nicotine Dependence Treatment Among Currently Depressed Smokers

Dr. Haug and colleagues at the University of California, San Francisco conducted this study to examine specific characteristics of psychiatric outpatients with depressive disorders who either accepted or refused available smoking cessation treatment. The sample (N=154) participated in a repeated contact experimental condition where they received a stage-based expert system program to facilitate treatment acceptance and were then offered smoking treatment, consisting of behavioral counseling, nicotine patch, and bupropion. Acceptors (N=53) were defined as those accepting behavioral counseling and pharmacological treatment at some point during the 18-month study, whereas refusers (n=101) received only the expert system. The number of days to treatment acceptance was significantly predicted by stage of change, with those in preparation entering treatment more quickly than contemplators or precontemplators. The variables most strongly associated with accepting treatment were current use of psychiatric medication and perceived success for quitting. Severity of depressive symptoms, duration of depression history, and history of recurrent depression were not related to treatment acceptance. The authors suggest that the findings have implications for the psychiatric assessment and treatment of smokers in clinical settings. Psychiatric medication may play a significant role in smoking cessation treatment acceptance by currently depressed smokers. Haug, N.A., Hall, S.M., Prochaska, J.J., Rosen, A.B., Tsoh, J.Y., Humfleet, G., Delucchi, K., Rossi, J.S., Redding, C.A. and Eisendrath, S. Nicotine and Tobacco Research, 7, pp. 217-224, 2005.

Contingency Management and Cognitive-Behavioral Treatment for Adolescent Marijuana Abuse Shows Promise

Investigators at the University of Vermont published data on an initial sample of 19 adolescents participating in a Stage-I treatment-development study targeting marijuana abuse and associated behavior problems. Adolescents participated in a 14-week treatment consisting of incentives for adolescent abstinence, parent involvement in delivering contingencies, clinic-delivered incentives to parents for participation in treatment, and individual cognitive-behavioral treatment for adolescents. The results suggest that families had high levels of participation in treatment, and that abstinence from marijuana increased significantly from treatment entry to completion (improving from 37% abstinence to 74% abstinence). This study reports on a unique combination of two behavioral interventions found to be beneficial in treating drug abuse-contingency management and family involvement-and demonstrates that the two can be efficacious in treating adolescent marijuana abuse. Kamon, J., Budney, A. and Stanger, C. Journal of the American Academy of Child and Adolescent Psychiatry, 44, pp 513-521, 2005.

Researchers Should Evaluate Costs of Treatment in Addition to Efficacy and Effectiveness

Recognizing the role of cost in the availability and dissemination of treatments for drug abuse and related co-morbidities, Dr. William Fals-Stewart of the Research Triangle Institute and colleagues published guidelines to assist clinical researchers in including cost evaluations in their studies. Using marriage and family treatments as a model, the authors outline user-friendly guidelines to identify and define key constructs (i.e., cost, benefit, effectiveness), and offer recommendations of how to assess and analyze these constructs. This paper serves as a valuable tool in equipping researchers to design comprehensive studies of drug abuse treatment. Fals-Stewart, W., Yates, B.T. and Klosterman, K. Journal of Family Psychology, 19, pp. 28-39, 2005.

Ecologically-Based Family Therapy Reduces Drug Abuse among Substance Abusing Runaway Adolescents

Dr. Natasha Slesnick, recently joining the faculty at Ohio State University, and colleague Jillian L. Prestopnik, report on the efficacy of a family-based behavioral treatment for substance abuse among runaway teens. Substance-abusing teens were recruited at a homeless shelter, and 124 were randomly assigned to receive Ecologically-Based Family Therapy (EBFT) or to receive services as usual (SAU). Teens receiving EBFT had significantly greater reductions in substance use than did teens receiving SAU, with those reporting a history of physical or sexual victimization achieving even better outcomes in EBFT. Other areas of functioning (psychiatric diagnoses, delinquent behaviors, family functioning, knowledge of HIV risk, etc.) improved significantly for teens receiving either EBFT or SAU. These results suggest that a family-based behavioral treatment has potential to improve substance abuse among a high-risk population of runaway teens, and that there may be several avenues to intervening in other areas of functioning. Slesnick, N. and Prestopnik, J. L. Journal of Adolescence, 28, pp. 277-298, 2005.

Gender Differences among HIV-Positive Methadone Maintenance Patients Enrolled in a Medication Adherence Trial

Dr. Haug and colleagues at UCSF examined gender differences among HIV + methadone maintained patients on antiretroviral medications. Participants were enrolled in a larger clinical trial, which included a 4 week observation period using electronic monitors to track medication adherence. Contrary to previous literature, no significant differences were detected between men (n=42) and women (n=36) on medication adherence or depression. Both groups showed poor adherence during baseline (M=56% of doses taken on time), high overall prevalence of depression (47%) and illicit cocaine use (47%). Women reported significantly more medication side effects (M=21.4 vs.14.9), higher severity of ASI psychiatric problems (M=0.50 vs. 0.40), and lower SF-36 health related quality of life in physical (M=42.1 vs. 63.3) and emotional functioning (M=26.9 vs. 58.9) than men. Women tested positive for opioids at higher rates than men (53% vs. 29%, respectively, whereas men were more likely to be positive for benzodiazepines than women (26% vs. 6%, respectively). The findings suggest that gender differences between male and female methadone maintenance patients have relevance to treatment providers. Comprehensive assessment, specialized medical care and mental health services may be necessary in the treatment of HIV positive female drug abusers. Haug, N.A., Sorensen, J.L., Lollo, N.D., Gruber, C.A., Delucchi, K.L. and Hall, S.M. AIDS Care, 17(8), pp. 1022-1029, 2005.

Variations in Patterns of Highly Active Antiretroviral Therapy ( HAART) Adherence

Strict adherence to HAART is necessary for successful suppression of HIV replication. A large number of individuals are non-adherent, however, and the reasons for non-adherence are varied and complex. Dr. Levine, Hinkin and colleagues at UCSF utilized cluster analyses to identify subgroups of adherers in a sample of 222 HIV positive individuals whose HAART use was electronically monitored. Five distinct subgroups were identified, with characteristic variations across the week and over the course of the 4-week study. Additional comparisons of demographic and behavioral variables found the poorer adherers to have higher rates of substance abuse, and that a group with higher rates of cognitive impairment had a consistent drop in adherence during the weekends. In addition, the group with the best adherence had more individuals over 50 years of age. The results suggest that interventions designed to improve adherence should be designed to accommodate this variability in adherence behavior. Levine, A.J., Hinkin, C.H., Castellon, S.A., Mason, K.L., Lam, M.N., Perkins, A., Robinet, M., Longshore, D., Newton, T., Myers, H., Durvasula, R.S. and Hardy, D.J. AIDS Behavior, 9(3), pp. 355-362, 2005.


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