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Biomedical subjects

D D Simpson

Publications and source records attributed to D D Simpson.

105 records · Page 6Linked to original sources
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Mapping-enhanced drug abuse counseling: urinalysis results in the first year of methadone treatment.

Urinalysis (UA) tests for opiates and cocaine were obtained over a 12-month period for a total of 155 long-term clients who participated in treatment in one of three urban methadone centers. At admission, clients were randomly assigned to "node-link mapping" (n = 82) or "standard" (n = 73) counseling treatment. Node-link mapping is a strategy for visually representing interrelationships between clients' ideas, feelings, and experiences. These multirelational maps are developed (usually by counselors) during individual and group counseling sessions to clarify clients' issues and problems. The results revealed that (a) mapping clients had significantly fewer opiate-positive UAs during months 2-6 of treatment and (b) session attendance was a significant predictor of cocaine-positive UAs over months 2-12 for mapping clients.

Adult↗
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Drug abuse treatment process components that improve retention.

BACKGROUND: Longer retention has been the most consistent predictor of favorable drug abuse treatment outcomes, but key therapeutic and patient engagement indicators of treatment process need to be more clearly established. METHODS: An integrative model representing treatment dynamics was tested for explaining long-term program retention. It was based on a multisite sample of 527 daily opioid users who remained in methadone maintenance a minimum of 3 months. All had been assigned randomly to a counseling condition at admission (i.e., cognitively enhanced or standard), and information obtained from patient files, as well as periodic assessments completed by patients and their counselors in the first 90 days after admission were the sources of predictors. RESULTS: Counseling enhancements (using node-link mapping, a visual representation tool for improving communication and problem solving) contributed to stronger therapeutic relationships between counselor and patient, which in turn had a positive reciprocal relationship with patient engagement (session attendance). Pretreatment motivation measured at intake was also related to higher engagement. More positive therapeutic relationships (in months 1 and 2) led to lower levels of during-treatment drug use (defined from urinalysis results in months 2 and 3), and better session attendance and therapeutic relationships both predicted longer retention. In addition, lower drug use during treatment was related to longer retention. CONCLUSIONS: Major conceptual domains of drug abuse treatment process were identified in community-based programs and their interrelationships with retention specified. As intermediate (during treatment) criteria, they can help guide functional improvements in program effectiveness as illustrated with our counseling enhancements.

Humans↗
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Residential drug abuse treatment for probationers. Use of node-link mapping to enhance participation and progress.

Node-link mapping, a graphic representation tool, was used to enhance substance-abuse treatment in a 4-month residential criminal justice program. Twelve communities of 30 to 35 probationers ("residents") were randomly assigned to either mapping-enhanced or standard counseling. During group sessions, counselors and residents in the mapping communities collaborated to develop node-link maps representing critical issues. Counselors in standard communities used their own methods. Treatment motivation (i.e., desire for help) was assessed at intake and was used to categorize residents into three levels. Treatment involvement was measured at the middle and at the end of the program. Residents, as well as their counselors, rated those in mapping communities as participating more in group sessions than those in standard communities. Mapping residents also reported better personal progress toward treatment goals, more positive affective responses to treatment, and greater treatment engagement. Residents with higher motivation at intake had higher treatment involvement scores regardless of type of counseling received.

Adolescent↗
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Effectiveness of a specialized intervention for women in a methadone program.

Over the past 20 years, specialized programming for chemically dependent women has been recommended for improving psychosocial functioning and retention in treatment. This study examined the impact of a structured, six-week assertiveness and sexuality workshop for women at three community-based methadone maintenance programs. Results indicated that women who participated frequently in the women's groups (four to six sessions) showed greater increases in self-esteem and knowledge compared to women who participated infrequently (one to three sessions). In addition, level of participation was positively associated with length of stay in the treatment program after completing the workshop.

Adult↗
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The use of node-link mapping in drug abuse counseling: the role of attentional factors.

This study extends previous research on the use of node-link mapping during counseling by addressing the effect that this visual representation technique has on clients with attentional problems. Participants were 13 counselors in a methadone treatment program and their 93 opioid-addicted clients who had been in treatment for more than three months. Both counselors and clients were randomly assigned to mapping-enhanced or standard counseling. Based on a self-report measure assessing attention-related problems of clients, they were categorized as having either adequate or poor levels of attentional stamina and attentional control. Consistent with previous findings, clients in mapping-enhanced counseling had lower percentages of urine samples that were positive for cocaine or heroin. In addition, results suggest that mapping has greater benefits in terms of session attendance and program perception for clients with poor attentional stamina.

Adult↗
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Using peer, self, and counselor ratings to evaluate treatment progress.

It is generally recognized that the evaluation of treatment progress requires multiple methods of assessment. To provide a basis for supplementing existing measures, the current study investigated the use of a peer rating methodology for evaluating the treatment progress of 381 probationers admitted to a four-month residential drug abuse facility. Self ratings of "working the program" (i.e., conscientiously participating in treatment) were compared with ratings by peers in the program and with ratings by counselors. Peer and counselor ratings were more highly correlated with each other than with client self ratings. Peer as well as self ratings detected differences between enhanced and standard counseling, and were related to individual difference measures known to be associated with treatment progress. In addition, peer midterm ratings of "working the program" were related to both self and counselor ratings of clients' endterm participation, and counselor ratings of the likelihood of remaining clean and sober. These findings support the use of peer ratings as additional indicators of treatment progress.

Alcoholism↗
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Evaluating corrections-based treatment for the drug-abusing criminal offender.

The recent increase in drug abusers in the criminal justice system has led to the expansion of corrections-based drug treatment facilities. Although three key evaluations have provided consistent support for the effectiveness of drug treatment within the criminal justice system, direct comparisons of outcomes across these evaluations are limited by variations in their measurement systems and the structure of official records on which they are based. This article addresses some of the issues relating to the assessment of treatment outcomes for the drug-abusing offender and provides several recommendations for future research.

Crime↗
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Client types in different drug abuse treatments: comparisons of follow-up outcomes.

Differences in background characteristics of 1,812 Black and White male opioid addicts were used as the basis for defining profiles of "typical" clients assigned to methadone maintenance (MM), therapeutic community (TC), and outpatient drug-free (DF) programs. The three client types defined by these profiles, especially reflecting variations in criminal history and legal involvement, were compared using a composite outcome measure for drug use, criminality, and employment during the first year posttreatment. There were significant outcome differences among the client types, and the client type with greater criminal involvement had the poorest outcomes. The outcomes of clients in MM, TC, and DF treatments were not significantly different from one another, but they were significantly more favorable than those for clients in outpatient detoxification and a comparison intake-only group. The major finding, however, was the lack of evidence for an optimal match between client types and treatment types leading to better posttreatment outcomes of clients.

Age Factors↗
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Status of opioid addicts 5 years after admission to drug abuse treatment.

A sample of 2,099 Black and White male daily opioid drug users admitted to drug abuse treatment programs located across the United States were followed up 5 to 6 years after admission. Follow-up interviews focused on posttreatment behavioral functioning, including drug and alcohol use, treatment reentry, criminality, and employment. The sample included Black and White males in the nationally oriented Drug Abuse Reporting Program (DARP) who were admitted to methadone maintenance (MM), therapeutic community (TC), outpatient drug-free (DF), and outpatient detoxification (DT) programs; in addition, intake-only (IO) who never returned to receive treatment in the DARP were included as a comparison group. This study examined the status of these former addicts during the year immediately before the follow-up interview. It was found that 60% of the total sample reported no opioid drug use and 78% reported no daily use. Furthermore, over one-third had no illicit drug use at all during the year, as well as no arrests or incarcerations in jail or prison. Long-term status was slightly more favorable for persons treated in DARP, MM, TC, and DF programs, compared to DT and IO clients. Limitations on the interpretations of these results and suggestions for further research are discussed.

Adult↗
PubMedDate not supplied

Recidivism among opioid addicts after drug treatment: an analysis by race and tenure in treatment.

Recidivism rates and recidivism proportions for return to a state of daily opioid use following discharge from drug abuse treatment were studied for a sample of Black and White male daily opioid users. The rates and proportions were analyzed by treatment type and time in treatment. Significantly higher recidivism proportions were found for shorter tenure clients.

Black or African American↗
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Modeling year 1 outcomes with treatment process and post-treatment social influences.

Follow-up studies of drug user treatment generally find significant improvements in client functioning, but information about the therapeutic components associated with client behavioral changes over time is limited. An integrative model developed previously to predict treatment retention was expanded and applied to post-treatment outcomes. This study is based on 321 daily opioid users treated in three methadone treatment clinics. Effects of pre-treatment motivation, treatment process measures representing therapeutic relationship, counseling session attendance, and length of treatment are examined in relation to measures of family relations, peer deviancy, return to treatment, drug use, and criminality in the year after treatment. Models were tested in two stages. The first was built on a during-treatment process model for predicting time in treatment to include post-treatment outcomes. The second model was expanded further to include the effects of intervening social support variables as predictors of post-treatment drug and criminality outcomes. The results supported both models and emphasize the importance of considering social influences and related community contextual factors that affect recovery dynamics.

Adult↗