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Biomedical subjects

A Alterman

Publications and source records attributed to A Alterman.

13 recordsLinked to original sources
PubMed1999

Revisiting the effectiveness of methadone treatment on crime reductions in the 1990s.

This study examines the relationship between methadone treatment and the criminal activity of 126 individuals participating in treatment during the early 1990s. The primary question addressed is to what extent is methadone maintenance treatment associated with reductions in crime? Although prior studies in the 1970s and early 1980s showed significant decreases in crime for individuals in treatment programs, criteria for remaining in this treatment modality have changed in recent years, particularly with the advent of acquired immune deficiency syndrome and the need to reduce intravenous drug use. A pre-post study design is employed spanning a 6-year time period of subject recruitment and follow-up (1987-1993). Uniform administrative records on arrests are used for the analyses. A multiple regression model is employed to explain the variance in the number of arrests 2 years following program admission, with prior criminal history, prior and current drug treatment, and current cocaine use employed as explanatory variables. Results indicate that treatment retention has only a slight, though significant, effect on reducing criminal activity during treatment. Two other factors that appear to increase arrest activity are the use of cocaine and prior criminal history. The fact that arrests did not decrease during a treatment period of 18 months on average requires more investigation in light of the increase in cocaine use in this population.

Adult↗
PubMed1999

Prior treatment history and its impact on criminal recidivism.

This study examines the hypothesis that treatment is a cumulative process; that is, treatment success is best viewed in terms of the patient's entire treatment history, rather than the index treatment episode. Three-hundred and eight patients with a primary heroin addiction were studied for 2 years posttreatment. Using posttreatment arrests as the dependent variable, the effects of prior treatment were assessed. Those with six or more prior treatment episodes and who had been in treatment for 12 or more months during the most recent episode averaged only 0.2 arrests in the 2 years posttreatment, while those with no prior treatment, but 12 or more months in the recent treatment averaged 0.88 arrests. Logistic analysis found that each prior treatment reduced the probability of a posttreatment arrest by 25%. Based on a linear regression, patients with six or more treatments prior treatments averaged half the number of posttreatment arrests as someone with no treatments before the index episode.

Adult↗
PubMed1997

Validity of three measures of antisociality in predicting HIV risk behaviors in methadone-maintenance patients.

Most opiate users are injection drug users (IDUs). A significant percentage of IDUs have antisocial personality disorder (APD). APD has been found by some researchers to be an additional risk factor for human immunodeficiency virus (HIV) infection in IDUs. The present study evaluated the association of sociodemographic characteristics, substance abuse history, and several measures of antisociality including the DSM-III-R diagnosis made by the Personality Disorder Examination, the California Psychological Inventory-Socialization Scale, and Hare's Revised Psychopathy Checklist, to behaviors associated with HIV risk in 289 opiate-dependent methadone-maintained subjects. The presence of drug- and sex-related risky behaviors measured by the Risk Assessment Battery was predicted more consistently by measures of personality traits associated with antisociality than by a diagnosis of APD.

Adult↗
PubMed1996

Amantadine in the early treatment of cocaine dependence: a double-blind, placebo-controlled trial.

A 4-week, double-blind, placebo-controlled trial of amantadine was conducted in 61 cocaine dependent outpatients. Subjects received 100 mg of amantadine 3 times daily. A follow-up visit was conducted at week 8. There were no significant differences between groups in treatment retention, or in the number of benzoylecgonine positive urine samples. Self-reported drug and alcohol use declined in both groups. At week 8 follow-up, self-reported drug use was significantly lower in the placebo group. Amantadine was not effective, and discontinuation of it may have been associated with an increase in cocaine use.

Adult↗
PubMed1996

DSM-IV antisocial personality disorder field trial.

The development of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) included 12 field trials to assess proposed revisions. This article provides results from the antisocial personality disorder (APD) field trial that was conducted to obtain data of relevance to the proposals for simplification and for the inclusion of more traditional traits of psychopathy. Provided herein are the results from 4 sites that had sampled from populations of particular relevance to the diagnosis of APD (i.e., prison inmates, psychiatric inpatients, outpatients with substance use disorders, and homeless persons). The results indicated that some items from the 3rd revised Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1987) could be deleted without affecting the diagnosis. The field trial provided mixed support for the proposal to include more traditional traits of psychopathy.

Adolescent↗
PubMed1992

Psychotherapy for cocaine dependence.

Dependence on cocaine is a new disorder for contemporary US clinicians. Until the 1980s sufficient quantities of the drug were not available to produce a true dependence. Thus far the only models for pharmacological intervention involve an interaction between medication and psychotherapy; that is, medication may be able to facilitate a drug-free interval during which time the patient can be engaged in psychotherapy. Psychotherapy programmes for cocaine dependence have generally been modelled on group-oriented treatments of the type used by Alcoholics Anonymous. Controlled studies of therapy programmes for cocaine dependence are currently being conducted and one prospective random-assignment study comparing day hospital and in-patient rehabilitation shows generally good results. Behavioural treatments aimed at reducing or extinguishing conditioned responses in cocaine addicts have also shown efficacy in a controlled study. More general relapse prevention procedures including rehearsal and role-playing are also used in the treatment of cocaine dependence. Combinations of psychotherapy and pharmacotherapy have so far shown the most promise in the treatment of this disorder.

Ambulatory Care↗
PubMed1992

Developing and evaluating new treatments for alcoholism and cocaine dependence.

Progress in the treatment of any disorder requires the development of methods for evaluation as well as the development of potentially effective new treatments. In this chapter we briefly describe a new instrument to be used in the measurement of substance abuse treatment, the Treatment Services Review. Some of the potential problems in evaluation research are discussed, such as the tendency for more severely ill patients to be more willing to give up their right to choose treatment and agree to randomization. These unexpected tendencies in study volunteers limit the generalizability of treatment research. Evaluation techniques are illustrated by two studies comparing inpatient and outpatient rehabilitation. The results for both alcohol dependence and cocaine dependence were positive, but there was no evidence of a significant advantage for one treatment environment over the other. This has important implications for program funding. We also describe our search for a new treatment technique based on a conditioning model for cocaine dependence. Pilot studies suggested an improvement in treatment outcome for the patients receiving the experimental treatment, and therefore, a prospective study with random assignment was conducted.

Alcoholism↗
PubMed1989

Evaluation of treatment for cocaine dependence.

1. At the Philadelphia VA Medical Center, veterans applying for treatment of cocaine dependence were significantly different from applicants dependent on opiates or alcohol without cocaine. The cocaine dependent patients were almost all black and they were mostly employed. Few were involved in crime and, for most, this was the first course of substance abuse treatment. Their use of cocaine began within the past three years and they had relatively few psychiatric, medical, employment or family problems when compared with other applicants for substance abuse treatment. 2. Completion rate for a course of outpatient treatment for cocaine dependence varies from a low of 37% in the general Day Treatment Program to 76% in a special Behavioral Treatment Program and 78% among methadone patients receiving an additional medication for cocaine dependence. Completion of a 28 day course of inpatient treatment was 86% whether the patient selected inpatient care or was assigned to it on a random basis. 3. Those outpatients who remained in treatment generally did well and refrained from cocaine use even during the course of outpatient, either day hospital treatment or behavioral treatment. When both inpatients and outpatients were re-examined four months after beginning treatment, there was significant improvement on almost all ASI categories. Both drop-outs and completers were re-examined. Despite the significantly greater completion rate for the patients assigned to inpatient treatment, both groups showed equal levels of improvements at the 4-month follow up point. 4. These preliminary results from five different treatment populations suggest that cocaine dependent patients can be engaged in treatment and that significant improvement is possible.

Adult↗
PubMed1988

Is inpatient medical alcohol detoxification justified: results of a randomized, controlled study.

The findings of this study revealed relatively few short-term outcome differences for patients meeting study criteria who were randomly assigned to either outpatient or inpatient medical detoxification. Given the higher costs of inpatient treatment, these findings suggest that outpatient detoxification be considered as a meaningful and cost-effective treatment for persons with mild to moderate alcohol withdrawal symptomatology.

Alcoholism↗
PubMed1983

Alcoholic seizures: intellectual and neuropsychological sequelae.

Alcoholics who experienced withdrawal seizures performed comparably to those who did not suffer seizures on intellectual and neuropsychological tests. Both groups, however, exhibited a number of impairments. The hypothesis that the withdrawal seizure is indicative of alcoholism severity and can serve as a marker for extent of neurological disturbance was not supported.

Alcoholism↗
PubMedDate not supplied

Training for and maintaining interviewer consistency with the ASI.

A short quiz of Addiction Severity Index (ASI) coding conventions was developed to identify coding inconsistencies within a large group of trained interviewers, as one step in an overall program of quality assurance monitoring. Problem items, in which less than 75% of the quiz respondents answered correctly, existed in almost every ASI section. The ASI quiz has proven helpful in identifying "drift" from the ASI standard procedures. Individually reviewing the results of the quiz with the respondents helped to reinforce the recognized coding rules. The authors discuss a system-wide quality assurance program for maintaining interviewer consistency. It is believed that coding convention measures of this type could be useful in the maintenance of standards in other research interviews and procedures.

Curriculum↗