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Biomedical subjects

E Gottheil

Publications and source records attributed to E Gottheil.

At least 19 recordsLinked to original sources
PubMed2001

The effect of therapist/patient race- and sex-matching in individual treatment.

AIMS: Equivocal findings of the effect that therapist and patient similarity plays in treatment outcome led us to examine the impact of race- and sex-matching on treatment retention and outcome for a sample of people seeking outpatient substance abuse treatment. DESIGN: Patient and therapist characteristics were crossed in a 2 x 2 factorial design. Matching effects were then tested using retrospective data. PARTICIPANTS: Participants were 116 African-American cocaine-dependent people. SETTING: The study site was a university-sponsored outpatient treatment facility located in an economically depressed area of a large Northeastern US city. MEASUREMENTS: Follow-up data were drawn from the Addiction Severity Index, the Risk for AIDS Behavior Inventory and a questionnaire measuring post-discharge need for treatment, employment and education. Retention was defined as the number of days inclusive between the last date of service and the date admitted. FINDINGS: No meaningful effects in favor of matching were observed on outcome measures. CONCLUSION: While matching therapists and drug-dependent people does not appear to be essential in promoting positive retention and outcome, limitations of this study that include sample size and the homogeneous demographic nature of those seeking therapeutic services at our facility lead us to conclude that replication with a larger number of therapists and patients is needed. In a different therapeutic setting, with a different population presenting for treatment, the mismatching of patients and therapists with respect to factors such as those explored here might well yield differing results.

Adult↗
PubMed2001

Correlates of employment: a cohort study.

Employment is often viewed as a potent indicator of substance abuse treatment outcome. This study was conducted to determine if personality and/or demographic characteristics of a cohort of unemployed substance dependent persons presenting for addiction treatment might predict employment 9 months postadmission. By using stepwise discriminant function analysis, seven variables predictive of employment were identified. The positive value of employment was clearly documented. Those who gained employment were functioning better with regard to social and drug-use parameters than those who did not.

Adult↗
PubMed2000

Cocaine intake by rats correlates with cocaine-induced dopamine changes in the nucleus accumbens shell.

Extracellular dopamine levels were determined by microdialysis in the core and shell of the nucleus accumbens and the frontal cortex of rats before and after an injection of cocaine (20 mg/kg, IP). After removal of the probes, these same animals were then tested for their voluntary intake of cocaine using the two-bottle, free-choice paradigm. Baseline dopamine levels and their responses to an injection of cocaine differed among the three brain areas. No significant correlations were found between baseline dopamine levels in any of the three brain regions and the voluntary cocaine consumption. A significant negative correlation was found between cocaine-induced increases in extracellular dopamine in the shell of the nucleus accumbens and the voluntary intake of cocaine (r = -0.73, p < 0.01). No such correlations were observed in the accumbens core region or the frontal cortex. These results provide further evidence of the role of the accumbal shell region in cocaine preference, and indicate that cocaine-induced increases in dopamine levels play a role in oral cocaine self-administration or preference. In addition, this relatively novel approach in using the same animals for both cocaine induced neurotransmitter responses and cocaine preference studies can also be applied for the study of other neurotransmitters and drugs of abuse.

Animals↗
PubMed1998

Therapist/patient race and sex matching: treatment retention and 9-month follow-up outcome.

AIMS: The current study was conducted to (a) replicate previous findings regarding the effect of patient/therapist race and sex-matching as this relates to the early dropout rate of substance abusers, and (b) to extend previous work by examining the impact of such matching on treatment retention and 9-month outcome. DESIGN: Patient and therapist characteristics were crossed in a 2 x 2 factorial design. Matching effects were then tested using retrospective data. PARTICIPANTS: Participants were 967 African-American cocaine-dependent people. SETTING: The study site was a university sponsored outpatient treatment facility located in an economically depressed section of a large Northeastern US city. MEASUREMENTS: Follow-up data were drawn from the Addiction Severity Index, the Risk for AIDS Behavior Inventory, and a questionnaire measuring post-discharge need for treatment, employment and education. Retention was defined as the number of days inclusive between the last date of service and the date of admission. FINDINGS: No significant differences in early dropout rates were found after initial contact with 10 different therapists. Matching therapist and patients with respect to gender and race did not decrease the premature dropout rate, but partial support for gender matching was noted. CONCLUSION: Matching therapist and substance abusing patients on gender and race may not be essential to improving retention and outcome.

Adult↗
PubMed1998

A randomized controlled study of the effectiveness of intensive outpatient treatment for cocaine dependence.

OBJECTIVE: A randomized controlled study design was used to compare the effectiveness of intensive outpatient treatment with individual outpatient counseling and a combination of individual and group outpatient counseling for cocaine-dependent patients. METHODS: Volunteers for this study were recruited from among first admissions to an inner-city, public-sector outpatient substance abuse clinic. In-treatment, end-of-treatment, and nine-month follow-up assessments were compared for participants randomly assigned for 12 weeks to one of three treatment modalities--weekly individual outpatient counseling, weekly individual counseling plus one weekly group session, or a newly designed intensive group treatment program consisting of three hours of group treatment three days a week. RESULTS AND CONCLUSIONS: Patients who completed the intensive program showed significant improvement from intake to end-of-treatment scores on the Addiction Severity Index, the Beck Depression Inventory, and the Symptom Checklist. At nine-month follow-up, patients who had remained in treatment longer had fewer drug problems, a smaller proportion of positive urine drug screening tests, a better employment status, and fewer psychological problems compared with patients who left treatment earlier. Patients who remained in treatment were also more likely to be attending self-help meetings, continuing in outpatient treatment, or attending school. However, for the 447 patients randomly assigned to the three conditions, there were no significant differences between treatment modalities on any of the variables at nine-month follow-up. The new intensive treatment program was not shown to be superior to more traditional treatment programs.

Adult↗
PubMed1998

Does intensive outpatient cocaine treatment reduce AIDS risky behaviors?

The purposes of this study were: (1) to examine the characteristics of 447 cocaine dependent, first admission outpatients in relation to their AIDS risky behavior at intake; (2) to ascertain whether there was a reduction in risky behavior at follow-up 9 months after admission; and (3) to determine whether reductions in risky behavior were related to patient characteristics, group as compared to individual treatment, or time in treatment. In this sample of cocaine dependent patients entering outpatient treatment, those engaging in higher AIDS risky behaviors were not characterized by any particular demographic profile or by a lack of knowledge about HIV/AIDS. They did have higher scores on the SCL-90-R symptom scales, the Beck Depression Inventory, and higher ratings on the Drug, Alcohol, Family, and Medical scales of the ASI. At 9-month follow-up, AIDS risky behaviors as measured by the RAB were found to have decreased significantly. The degree of improvement was not associated with demographic variables but was predicted by higher intake problem severity and psychological symptomatology scale scores. While improvement in risky behavior was not related to type of treatment or duration of treatment, it was related to decreased substance use. The individuals whose risky behavior decreased were those whose substance use had decreased. Improvement, then required not only being in a treatment program, but also participation and involvement in the program. Treatment and not merely attendance would seem to be critical.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Medical students' personal values and their career choices a quarter-century later.

A longitudinal study of 391 physicians tested two hypotheses regarding personal values and career choices: that higher preference for social values would be associated with physicians' being more interested in "people-oriented" rather than "technology-oriented" specialties and that higher preference for economic values would be associated with expectations of high income. The physicians (344 men, 47 women) were graduates of Jefferson Medical College in 1974 and 1975 who completed the Allport-Vernon-Lindzey Study of Values during medical school. Analysis showed that physicians currently in the "people-oriented" specialties scored significantly higher on the Social Value scale than their peers in "technology-oriented" specialties. A moderate but statistically significant correlation was found between scores on the Economic Value scale and expectations of higher income. The findings suggest that physicians' personal values are relevant to their career decisions such as specialty choice and expectations of income. The findings have implications with regard to two major issues in the evolving health care system, namely, the distribution of physicians by specialty and cost containment.

Adult↗
PubMed1997

Underreporting of cocaine use at posttreatment follow-up and the measurement of treatment effectiveness.

Substance abusers, especially cocaine abusers, may underreport their substance use in outcome interviews. Follow-up interviews were conducted and urine specimens were obtained on 633 persons 9 months after admission to a 3-month cocaine treatment program. Although 422 (67%) reported no use of cocaine in the past 30 days, 134 of these (32%) had cocaine-positive urines. This group did not differ on most characteristics at intake or follow-up from the 288 with cocaine-negative urines. The amount of treatment received did affect willingness to admit drug use. Of 132 treatment completers who reported no cocaine use at follow-up, 21 (16%) had positive urines. Of 91 early dropouts who also reported no cocaine use, 36 (40%) had positive urines. This differential rate of underreporting had the effect of seriously underrepresenting the effectiveness of treatment completion as compared with little or no treatment.

Adult↗
PubMed1997

Pretreatment dropouts: characteristics and outcomes.

The characteristics and outcome results of 123 cocaine dependent patients who dropped out following intake without returning for even one treatment visit were compared with those of 324 who did return and received at least one treatment service and 118 who remained on the program for two months or more. The pre-treatment dropouts were more often positive for cocaine on admission drug screens and less often employed. They reported fewer psychological symptoms on the scales of the SCL-90 and received lower scores on the medical problem severity scale of the ASI. At 9-month follow-up they were found to have less often attended self-help meetings or continued in outpatient treatment, more often to have been admitted for inpatient treatment or been in jail, less often returned to school and were more often using cocaine. Clearly, clinicians and researchers need a better understanding of these patients who account for significant attrition, have distinguishing characteristics, and do much more poorly than those who remain in treatment.

Adult↗
PubMed1997

Randomized comparison of intensive outpatient vs. individual therapy for cocaine abusers.

One of the fastest growing approaches to treating cocaine addiction is intensive outpatient treatment (INT). Nevertheless, there have been no previously reported controlled clinical trials comparing this approach to the more traditional (IND) or individual plus group (IND-GRP). This early report of the results of a clinical trial comparing these three approaches indicated that patients who remained in treatment and completed a twelve-week course of care demonstrated significant improvements in drug use and psychological functioning. However, INT, IND, and IND-GRP did not differ on any of the assessments made during treatment or at treatment completion. The results underscored the importance of remaining in a course of care in order to effect behavioral change. A next step would involve a systematic comparison of those persons who do best in each modality in an effort to define the variables which could help match a patient to a treatment in which he/she is most likely to remain.

Adult↗
PubMed1997

Treatment structure, client coping methods, and response to brief individual counseling: preliminary findings in a substance dependent sample.

In this paper we report preliminary treatment outcome findings for the first 16 substance abuse patients who volunteered and qualified for a 12-week research-treatment program. Eight patients were exposed to a high-structure, behaviorally-oriented (HSB) individual counseling style, while the remaining eight were exposed to a low-structure, facilitative (LSF) style. 'Counselor effects' were controlled by having each of four counselors conduct both styles (two patients each) in serial but counterbalanced order; under these conditions treatment outcomes did not differ for patients randomly assigned to the different counselors. Outcomes also did not differ for the HSB and LSF clients with regard to retention, drug and alcohol use during treatment or for reported symptom reduction during the program as measured by the Addiction Severity Index. Though the LSF clients reported receiving more treatment benefits than did the HSB patients in their post-session ratings, this was not confirmed in the counselors' post-treatment ratings or in the other treatment response measures. Finally, with a few exceptions, patients scoring higher versus lower on four measures of coping, including conceptual and developmental levels of functioning, field independence and social independence, did not differ in their treatment outcomes.

Adaptation, Psychological↗
PubMed1997

Outreach engagement efforts: are they worth the effort?

The present study was conducted to evaluate the efficacy of an outreach strategy designed to engage substance-abusing individuals who did not keep their initial treatment appointment. After missing their first scheduled appointment, telephone contact was attempted for 267 consecutive prospective patients as part of an attempt to engage them in treatment. Results indicated that this telephone contact was useful at prompting these individuals to both reschedule and arrive for intake. Our concern that persons who failed to keep initial appointments might be less motivated for treatment was not supported, as results indicated that treatment retention for these subjects was similar to that of a sample of individuals who arrived for intake as scheduled. These results support the value of outreach efforts as a means of engaging substance-abusing individuals who otherwise might not have experienced treatment.

Black or African American↗
PubMed1997

Patient treatment choice and compliance. Data from a substance abuse treatment program.

The authors tested the hypothesis that patients (treatment-seeking cocaine-dependent persons) given the opportunity to choose between treatment approaches would do better than patients randomly assigned to the same approaches in treatment retention and 9-month outcome. Subjects were 34 patients who voluntarily chose to enter individual therapy 1 hour per week (IND) and 33 who chose intensive group therapy for 3 hours, 3 times weekly (INT). There were no significant differences between these two groups on demographic, personality, or addiction severity variables or in treatment retention or 9-month outcome. Comparison with samples of 30 patients who had been randomly assigned to IND and 30 to INT did not confirm the hypothesis that patients who chose their treatment would either remain in treatment for longer periods of time or manifest improved 9-month outcomes. The authors raise several motivational issues.

Adult↗
PubMed1996

Learned helplessness and cocaine dependence: an investigation.

Low personal control and a sense of meaninglessness of life, attributes associated with a pattern of human learned helplessness, have also been described as contributing to the onset of adolescent drug use, as well as the maintenance of chronic substance abuse. However, despite its intuitive appeal as an etiologic factor, the absence of psychometrically sound and easily administered measures of learned helplessness has limited the ability of researchers to empirically test its role in the addiction process. Accordingly, the publication by Quinless and Nelson (1988) of a relatively brief Learned Helplessness Scale (LHS) led us to administer it to a sample of 30 consecutive cocaine dependent individuals seeking treatment for the first time at our facility. Our results indicated that the LHS was internally consistent when administered to this clinical sample and that theoretically meaningful and statistically significant relationships with other measures of psychological functioning were observed. Moreover, scores on the LHS were related to treatment retention/outcome.

Adult↗
PubMed1995

Prediction of length of stay in an inpatient dual diagnosis unit.

The institution of prospective payment systems, in which flat fees are paid per discharge, raised the concern that hospitals might preferentially admit patients expected to have a short length of stay (LOS). This concern presupposes that intake workers could accurately predict psychiatric hospitalization LOS, but this does not appear to have been empirically demonstrated. Accordingly, we examined the ability of two psychiatrists heading separate treatment teams on an inpatient, dual-diagnosis unit and a program coordinator who worked with both teams to predict LOS for 94 patients consecutively admitted to one or the other of these teams. Predictions were highly consistent across the raters and were significantly correlated with actual LOS (r = 0.25, 0.35, and 0.45 for the three raters). However, we found that the psychiatrists were accurate predictors only for patients for whom they were the attending psychiatrist. The program coordinator, who was involved in the treatment of all patients, was an accurate predictor for the patients of either psychiatrist. We concluded that the relationships found between predicted and actual LOS held true only when the rater also influenced treatment management and discharge. Our results do not support the proposition that specialized intake workers independent of those providing care would be able to predict LOS accurately.

Adult↗
PubMed1995

Gender differences and similarities in African-American crack cocaine abusers.

Recent interest in women's health and patient-treatment matching has focused attention on gender differences among substance abusers. This article seeks to extend research in this area to African-American crack cocaine abusers. It describes gender differences and similarities in a large sample (652 males and 595 females) of this important group of patients at a publicly funded, inner-city intensive outpatient clinic. As in previous studies on white working-class inpatients, few significant gender differences were found on demographic characteristics or drug use or treatment histories. Moreover, there were few differences in psychiatric symptomatology, and none in treatment participation or retention. In contrast to some reports, we did not find that women entered treatment with higher levels of depression than men. Most statistically significant differences we found were either too small to be of practical importance, or reflected conventional gender differences (e.g., women were more likely to care for dependents).

Adult↗