Readability of patient handout materials in a nationwide sample of alcohol and drug abuse treatment programs.

The objective of this study was to assess the readability of a nationwide sample of alcohol and drug abuse treatment programs' materials. Of 646 programs that were randomly selected from the National Clearinghouse for Alcohol and Drug Information directory, 52 programs returned completed materials. The average readability grade level of materials was 11.

Improving the care of individuals with schizophrenia and substance use disorders: consensus recommendations.

National attention continues to focus on the need to improve care for individuals with co-occurring mental illnesses and substance use disorders, as emphasized in the 2003 President's New Freedom Commission Report on Mental Health and recent publications from the Substance Abuse and Mental Health Services Administration (SAMHSA). These reports document the need for best practice recommendations that can be translated into routine clinical care. Although efforts are underway to synthesize literature in this area, few focused recommendations are available that include expert opinion and evidence-based findings on the management of specific co-occurring disorders, such as schizophrenia and addiction.

Does recovery from substance use disorder matter in patients with bipolar disorder?

Objective: To examine the potential impact of recovery from substance use disorder (SUD) on the course of bipolar disorder among patients diagnosed with both bipolar and substance use disorders according to DSM-IV criteria.

Method: As part of the multicenter Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), we examined bipolar disorder status (i.e.

Anxiety disorders among patients with co-occurring bipolar and substance use disorders.

Bipolar and substance use disorders are known to co-occur frequently, but limited attention has been paid to anxiety disorders that may accompany this dual diagnosis. Therefore, we examined the prevalence and nature of anxiety disorders 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 post-traumatic stress disorder (PTSD) occurring most frequently (n = 21, 23%).

Group therapy for substance use disorders: what do we know?

Although group therapy is the most prevalent treatment modality for substance use disorders, an up-to-date review of treatment outcome literature does not exist. A search of the literature yielded 24 treatment outcome studies comparing group therapy to other treatment conditions. These studies fell into one of six research design categories: (1) group therapy versus no group therapy; (2) group therapy versus individual therapy; (3) group therapy plus individual therapy versus group therapy alone; (4) group therapy plus individual therapy versus individual therapy alone; (5) group therapy versus another group therapy with different content or theoretical orientation; and (6) more group therapy versus less group therapy.

The effect of 12-step self-help group attendance and participation on drug use outcomes among cocaine-dependent patients.

Objective: Although cocaine-dependent patients are frequently referred to 12-step self-help groups, little research has examined the benefits of 12-step group attendance in this population. Moreover, the distinction between attending meetings and actively participating in 12-step activities has not typically been examined.

Method: In the National Institute on Drug Abuse Collaborative Cocaine Treatment Study, 487 cocaine-dependent outpatients were recruited at five sites for a randomized controlled trial of 24-week behavioral treatments.

Treating patients with bipolar disorder and substance dependence: lessons learned.

Although bipolar disorder is the Axis I psychiatric disorder associated with the highest rate of co-occurring substance use disorders, little research has focused on treatments specifically designed for these patients. The author and his colleagues have developed and studied Integrated Group Therapy (IGT) for this population. This paper describes common themes that have emerged in carrying out IGT for patients with bipolar disorder and substance dependence.

Adherence to pharmacotherapy in patients with alcohol and opioid dependence.

Aims: An important factor that has thus far limited the effectiveness of pharmacotherapies for patients with alcohol and opioid dependence is poor adherence to medication regimens. This paper presents a review of issues related to medication adherence in patients with these substance use disorders.

Design And Methods: A literature review was conducted of English language publications relating to medication adherence among patients with alcohol or opioid dependence.

Substance use histories in patients seeking treatment for controlled-release oxycodone dependence.

The characteristics of patients currently abusing controlled-release (CR) oxycodone admitted for inpatient detoxification were ascertained from medical record review of 48 inpatients with CR oxycodone dependence. Patients were categorized according to the manner in which they initially received the drug: illicitly or by prescription for legitimate medical use. Fifteen of the 48 patients (31%) initially obtained a CR oxycodone prescription legitimately for a medical condition.

Treatment utilization by women with PTSD and substance dependence.

This study reports the treatment utilization of 77 women with post-traumatic stress disorder (PTSD) and substance dependence in three areas: lifetime utilization, past thirty days utilization, and perceived helpfulness/harmfulness of current treatments. Results indicated high lifetime treatment utilization overall, yet, for one subgroup, no treatment exposure at all. Most current treatments were focused on SA, in striking contrast to participants' preference: over 80% would choose either combined SA/PTSD treatment or PTSD-alone treatment.

Pharmacotherapy for bipolar disorder and comorbid conditions: baseline data from STEP-BD.

Relatively absent from previous studies of the pharmacotherapy for bipolar disorder is examination of the impact of comorbidity on treatment choices. This has occurred despite the presence of high levels of comorbid anxiety and substance use disorders, and the association of these disorders with severity and course markers of bipolar disorder. In this study, we examined comorbid disorders, identified by structured interviews, and the pharmacotherapy reported at study entry by the first 1000 patients entered into a large, multicenter study of bipolar disorder (Systematic Treatment Enhancement Program for Bipolar Disorder).

Domestic violence in women with PTSD and substance abuse.

This study reports rates of domestic violence for women with posttraumatic stress disorder (PTSD) and substance dependence. The Conflict Tactics Scale-Revised (CTS2) was used to assess the rates of both physical and psychological aggression, lifetime and current, by self and partner. Results showed substantial rates, both lifetime and current by both partner and self and, for a substantial number in the sample, for multiple events within the past year.

Substance use and perceived symptom improvement among patients with bipolar disorder and substance dependence.

Background: Bipolar disorder (BPD) is the Axis I disorder with the highest risk for coexisting substance use disorder. One explanation for this phenomenon is the 'self-medication hypothesis', which states that some patients experience improvement in psychiatric symptoms as a result of substance use. We thus investigated reasons for substance use and perceived substance-induced improvement in BPD symptoms among patients with current BPD and substance dependence.

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.

Psychosocial treatments for cocaine dependence.

Psychosocial treatment remains the predominant modality of treatment for patients with cocaine dependence. This paper reviews several recent studies comparing different types of psychosocial treatments for this population. A number of forms of psychosocial treatment for cocaine dependence have shown promising results, as detailed in the study descriptions.

Limiting inpatient substance use treatment: what are the consequences?

This study tested whether a managed care policy of substituting outpatient for inpatient treatment of substance use disorders shifted treatment costs to psychiatric providers. This was an observational study, based on administrative data of 25,450 adult disabled Medicaid beneficiaries treated for schizophrenia and major affective disorders. Eighteen percent had a diagnosis of substance use disorder.

The relationship between educational attainment and relapse among alcohol-dependent men and women: a prospective study.

Background: We investigated the relationship between educational attainment and drinking outcomes after discharge from inpatient treatment for alcohol dependence.

Methods: Between 1993 and 1996, we consecutively recruited 41 women and 60 men hospitalized for alcohol dependence and followed them up monthly for 1 year. We conducted structured interviews during hospitalization and at monthly intervals after discharge for 1 year.

The relationship between cocaine craving, psychosocial treatment, and subsequent cocaine use.

Objective: Regular measurement of craving during treatment for cocaine dependence can monitor patients' clinical status and potentially assess their risk for drug use in the near future. Effective treatment can reduce the correlation between craving and subsequent drug use by helping patients abstain despite high craving. This study examined the relationship between cocaine craving, psychosocial treatment, and cocaine use in the ensuing week.

Past anabolic-androgenic steroid use among men admitted for substance abuse treatment: an underrecognized problem?

Background: Recent reports suggest that anabolic-androgenic steroids (AAS) may cause mood disorders or dependence syndromes and may help to introduce some individuals to opioid abuse. At present, however, little is known about prior AAS use among men entering inpatient substance abuse treatment.

Method: We assessed lifetime AAS use in 223 male substance abusers admitted to a substance abuse treatment unit primarily for treatment of alcohol, cocaine, and opioid dependence.

What general psychiatrists ask addiction psychiatrists: a review of 381 substance abuse consultations in a psychiatric hospital.

We reviewed the records of 381 consecutive substance abuse consultations completed by the Substance Abuse Consultation Service (SACS) of McLean Hospital to ascertain 1) the most frequent reasons why general psychiatrists consulted the SACS, and 2) the clinical characteristics of these patients. The most frequent reasons for consultation were to make aftercare recommendations (66.1%) or to make (19.

History of abuse and drinking outcomes following inpatient alcohol treatment: a prospective study.

Little is known about the impact of sexual or physical abuse history on response to alcohol treatment. This prospective study investigated the relationships between sexual and physical abuse histories, participants' characteristics, and response to inpatient alcohol treatment. Forty-one women and 59 men were assessed monthly for 1 year following hospitalization for alcohol dependence.

Medical morbidity, mental illness, and substance use disorders.

Objective: Previous research on the prevalence of medical disorders among adults with mental illness has been inconclusive. In general, studies have found higher rates among persons with mental illness, but these studies did not account for comorbid substance use disorders. The authors examined whether certain medical disorders are more prevalent among adults with severe mental illness and whether a comorbid substance use disorder increases prevalence beyond the effect of severe mental illness alone.