Therapist success and its determinants.

This study examined the relatively unexplored contribution of the therapist's performance in determining outcomes of treatment. Nine therapists were studied: three performed supportive-expressive psychotherapy; three, cognitive-behavioral psychotherapy; and three, drug counseling. Profound differences were discovered in the therapists' success with the patients in their case loads.

Psychiatric disorders in opioid-dependent patients.

An examination of substance abusers in contemporary practice reveals a high frequency of psychiatric disorders. In some cases, these probably represent preexisting conditions, but in others the disorder may be initiated or aggravated by the biologic and social consequences of substance abuse. The severity of a patient's psychiatric disorder is predictive of response to substance abuse treatment.

Severity of psychiatric symptoms as a predictor of benefits from psychotherapy: the Veterans Administration-Penn study.

One hundred ten nonpsychotic opiate addicts were randomly assigned to receive paraprofessional drug counseling alone, counseling plus cognitive-behavioral psychotherapy, or counseling plus supportive-expressive psychotherapy. Patients were classified low-severity, mid-severity, or high-severity on the basis of the number and severity of their psychiatric symptoms. Overall, the addition of professional psychotherapy was associated with greater benefits than was drug counseling alone.

The psychiatrically severe drug abuse patient: methadone maintenance or therapeutic community?

The present research was conducted to examine the effects of pretreatment psychiatric status and treatment duration on improvement following drug abuse rehabilitation. Percent improvement from admission to 6-month follow-up was measured on three criteria: drug use, employment, and criminality. Analyses of the total samples in both the Therapeutic Community (TC) and Methadone Maintenance (MM) programs indicated some quantitative differences between the two modalities but all measures showed a strong and positive relation between treatment duration and percent improvement.

Treatment of behavioral and psychiatric problems associated with opiate dependence.

Many difficult and complex behavioral and psychiatric problems can occur in a methadone treatment program. Some behavioral problems are very serious, and it is essential that the program place a high priority on controlling them. This is best done by structuring the treatment milieu via program rules.

Increased effectiveness of substance abuse treatment. A prospective study of patient-treatment "matching".

An earlier study retrospectively evaluated the effectiveness of six separate substance abuse treatment programs and generated a set of hypotheses for matching patients to the most appropriate programs. In the present study, these predictors and the matching strategy were tested in a prospective design, using the same treatment programs and a new sample of 130 alcohol- and 256 drug-dependent patients. The new group of patients who were treated in their predicted program (matched patients) were compared with those patients from the same sample who were not treated in their predicted program (mismatched patients).

Psychotherapy for opiate addicts. Does it help?

Opiate addicts beginning a new treatment episode on a methadone maintenance program were offered random assignment to drug counseling alone or to counseling plus six months of either supportive-expressive psychotherapy or cognitive-behavioral psychotherapy. Sixty percent of patients meeting the study criteria expressed an interest and 60% of these actually became engaged. One hundred ten subjects completed the study intake procedure and kept three or more appointments within the first six weeks of the project.

Predicting response to alcohol and drug abuse treatments. Role of psychiatric severity.

Male alcoholics (n = 460) and drug addicts (n = 282) were evaluated at six-month follow-up after treatment in six rehabilitation programs. Initial analyses of the unstratified samples showed significant patient improvement, but no evidence of differential effectiveness from different treatments or from "matching" patients to treatments. The two samples were then divided into groups based on the number, duration, and intensity of their psychiatric symptoms at admission, ie, their overall "psychiatric severity.

Psychotherapy for opiate addicts.

An opportunity to receive a six-month course of professional psychotherapy in addition to paraprofessional counseling was offered to opiate addicts who were beginning a new treatment episode on a methadone maintenance program. The treatments offered were drug counseling alone (DC), counseling plus supportive-expressive psychotherapy (SE), or counseling plus cognitive-behavioral psychotherapy (CB). Sixty percent of patients meeting the study criteria expressed an interest in the psychotherapy program and 60% of these actually became engaged.

Is treatment for substance abuse effective?

Few studies have assessed adequately the effectiveness of alcohol and drug abuse treatments using an appropriate range of reliable outcome measures, a representative sample of alcohol and drug abuse treatment modalities, or more than one perspective on treatment effectiveness. This article evaluates substance abuse treatment using a sample of 742 patients treated in six programs and evaluated at six-month follow-up. The following three major questions were addressed: (1) do patients improve following treatment; (2) are improvements confined to alcohol or drug use, or are they more pervasive; and (3) are these improvements a result of treatment? The results indicated significant and pervasive improvements in virtually all areas for both alcoholics and drug addicts.

Propoxyphene and norpropoxyphene kinetics after single and repeated doses of propoxyphene.

Plasma concentrations of propoxyphene (P) and its pharmacologically active metabolite norpropoxyphene (NP) were determined in normal subjects after single 130-mg oral doses and during and after 13 consecutive oral doses of 130 mg P, and in former heroin addicts who were maintained on 900 to 1200 mg of P per day. The data were analyzed using a first-pass elimination pharmacokinetic model. Both P and NP cumulated during repeated dosing to levels 5 to 7 times those after the first dose.

Propoxyphene form maintenance treatment of narcotic addiction.

Two studies compared propoxyphene napsylate (Darvon-N) with methadone hydrochloride as maintenance treatment for narcotic addicts. Most measures indicated that methadone was more effective than propoxyphene as a maintenance drug. Patients receiving propoxyphene reported more withdrawal-related symptoms early in treatment, tended to drop out sooner than patients receiving methadone, and were more likely to abuse heroin.

Are the "addiction-related" problems of substance abusers really related?

The "addiction-related" medical, social, and psychological problems of substance abusers are often considered by-products of prolonged alcohol or drug abuse which will be generally improved following achievement of abstinence. As a test of this view, measures of problem severity in six areas commonly related to addiction were intercorrelated in 460 alcoholic and 282 drug addicted male veterans. Both before and after treatment, the low intercorrelations in each sample indicated little relation between the severity of alcohol or drug use and the severity of the other problem areas.