Measuring confrontation during recovery from addiction.

The effect of confrontation on recovery from addiction continues to be a topic of considerable debate. Although many residential treatment programs view some form of confrontation as an integral part of recovery, a number of studies have found confrontation from professional treatment staff to be counterproductive. One of the problems inherent in the current debates about confrontation is the lack of a comprehensive measure of confrontation that assesses different dimensions.

Pharmacokinetics, safety, and tolerability of a depot formulation of naltrexone in alcoholics: an open-label trial.

Background: Naltrexone is an effective medication for treatment of alcohol dependence, but its efficacy is limited by lack of adherence to the oral dosage form. A long-acting depot formulation of naltrexone may increase adherence.

Methods: A single site, 6-week open label study was conducted with 16 alcohol dependent subjects each receiving 300 mg of Naltrexone Depot by intramuscular injection.

Psychiatric severity and spirituality, helping, and participation in alcoholics anonymous during recovery.

Although helping others is a critical part of Alcoholics Anonymous (AA) and many treatment programs, measures for assessing helping and describing its relationship with sobriety are lacking. A sample of 200 subjects completed a Helper Therapy Scale including three subscales: Recovery Helping (alpha = 0.78), Life Helping (alpha = 0.

Probation officers' beliefs about the effectiveness of alcohol treatment.

Research has shown that a large number of individuals on probation have alcohol problems but only a fraction of them receive treatment. This study surveyed 145 probation officers about their views on alcohol problems among probationers. A previous analysis of the data found that two beliefs predicted probation officers' use of coercion to mandate probationers to alcohol treatment: the belief that treatment was effective and the belief that one's peers were using coercion to mandate treatment.

The case for high-dose motivational enhancement therapy.

Motivational Enhancement Therapy (MET) is a brief therapy for treating substance use-related problems that draws upon the stages of the change model of Prochaska et al. (1992) and the clinical techniques of Motivational Interviewing (MI) Miller et al. (1992).

Factors associated with probation officers' use of criminal justice coercion to mandate alcohol treatment.

Alcohol problems are widespread among individuals in county criminal justice probation systems. However, it is unclear why only a small fraction of these problem drinkers receive treatment. In this study, self-administered questionnaires were mailed to 145 probation officers in nine California counties to identify factors that predicted probation officers' use of coercion to mandate alcohol treatment.

Patterns and trends of drug use in the San Francisco Bay Area.

In December 2002, the author conducted a comprehensive review of indicators of use of illicit substances in the San Francisco Bay Area. Cocaine use prevalence appears to be rising again, after a significant decline in the late 1990s. The shift away from smoking crack and toward snorting powder cocaine persists.

MDMA misrepresentation: an unresolved problem for Ecstasy users.

The demand for MDMA (methylenedioxymethamphetamine) has increased, especially among teenagers 12 to 18 years old. It is estimated that approximately 2.8 million teens have at least tried this drug.

Rethinking confrontation in alcohol and drug treatment: consideration of the clinical context.

The role of confrontation in the treatment of substance misuse problems is widely debated in the field. Historically, confrontation of denial has been important in treatment, particularly in residential programs. However, confrontation has also been criticized as counterproductive.

Can HCV be prevented among injection drug users?

The hepatitis-C virus (HCV) spreads rapidly among injection drug users (IDUs) because each act of sharing injection equipment carries a high risk of transmission. IDUs are hard to reach, especially in the early stages of their drug-using careers. IDUs are also poorly organized for self-help.

Drug testing in the workplace: integrating medical review officer duties into occupational medicine.

The authors discuss the social and political climate of drug testing in the workplace, the role of the medical review officer, Federal guidelines, and toxicology methods. The Americans with Disabilities Act is also briefly discussed, and the chapter closes with a case study.

Drug and alcohol offenders coerced into treatment: a review of modalities and suggestions for research on social model programs.

Outcome studies on drug and alcohol offenders coerced into treatment by the criminal justice system were reviewed. Positive outcomes were found for therapeutic community, methadone maintenance, and unspecified residential and outpatient programs. No outcome studies were found for court-mandated clients coerced into social model recovery programs.

Craving predicts use during treatment for methamphetamine dependence: a prospective, repeated-measures, within-subject analysis.

Clinical lore dictates that craving drives the compulsive use of drugs and alcohol - the core feature of substance dependence. Yet limited research has yielded mixed results, suggesting that craving is neither necessary nor sufficient for continued use or relapse to addictive substances. To investigate the role of craving in compulsive methamphetamine use, 31 men and women in treatment for methamphetamine dependence were asked to indicate, once each week for 12 weeks, the severity of craving that they had experienced during the previous 24 h, using a 100-mm visual analog scale.

Sober living houses: potential roles in substance abuse services and suggestions for research.

'Sober living houses' are alcohol- and drug-free residences for individuals attempting to establish or maintain sobriety. They offer no formal treatment services but do provide social support and an abstinent living environment. 'Sober living houses' have been used as aftercare placements for clients completing residential treatment, places for clients to live while attending outpatient treatment, or as stand-alone approaches for substance misuse problems.

Abuse and therapeutic potential of gamma-hydroxybutyric acid.

Gamma-hydroxbutyric acid is a compound found in mammalian brain that is structurally related to the neurotransmitters gamma-aminobutyric acid and glutamic acid. Gamma-hydroxybutyric acid effects dopaminergic systems in the brain and may be a neurotransmitter. Gamma-hydroxybutyric acid was first reported as a drug of abuse in 1990 and continues to be abused by bodybuilders, participants of "rave" dance parties, and polydrug abusers.

Abuse potential of dronabinol (Marinol).

Dronabinol is an oral form of delta-9-tetrahydrocannabinol indicated for treatment of anorexia associated with weight loss in individuals with AIDS, and nausea and vomiting associated with cancer chemotherapy. The authors reviewed the literature and conducted surveys and interviews among addiction medicine specialists, oncologists, researchers in cancer and HIV treatment, and law enforcement personnel to determine the abuse liability of dronabinol. There is no evidence of abuse or diversion of dronabinol.

Gamma-hydroxybutyrate: an emerging drug of abuse that causes physical dependence.

Gamma-hydroxybutyrate (GHB) is a compound found in mammalian brain which meets many criteria of a neurotransmitter. GHB has been investigated as a tool for inducing absence (petit mal) seizures, for use as an anesthetic, and for treatment of narcolepsy, alcohol dependence and opiate dependence. Since 1990 GHB has been abused in the United States for euphoric, sedative and anabolic effects.

A controlled trial of imipramine for the treatment of methamphetamine dependence.

At the Drug Detoxification Program of the Haight Ashbury Free Clinics, we conducted a randomized clinical trial of imipramine in the treatment of methamphetamine dependence. The purposes of the trial were to test the efficacy of imipramine as a treatment for methamphetamine dependence and to establish the feasibility of conducting a controlled clinical trial at the Clinic. Thirty-two subjects were randomly assigned to receive either 10 or 150 mg/day of imiprine for 180 days.

A historically controlled trial of tyrosine for cocaine dependence.

Cocaine dependence continues to be a major public health problem and efforts to develop pharmacotherapies have been disappointing. Chronic cocaine use is believed to cause catecholamine depletion and similarities exist between cocaine withdrawal and major depression. Tyrosine is the dietary precursor to catecholamines and has yielded positive results in small trials of its antidepressant efficacy.

Abuse of flunitrazepam (Rohypnol) and other benzodiazepines in Austin and south Texas.

Flunitrazepam (Rohypnol) is a benzodiazepine sedative-hypnotic that has generated significant media attention in the United States because of its abuse and its association with "date rape." A field investigation was conducted in south Texas to ascertain the nature and consequences of the abuse of flunitrazepam. In semistructured interviews, 66 subjects identified as flunitrazepam users were asked about their use of alcohol and other drugs and their sexual behaviors.