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Biomedical subjects

J S Cacciola

Publications and source records attributed to J S Cacciola.

At least 37 records · Page 2Linked to original sources
PubMed1998

A typology of antisociality in methadone patients.

Multistage cluster analyses with replications were used to sort score profiles of 252 methadone maintained men on 4 continuous measures of antisociality--childhood conduct disorder and adult antisocial personality disorder symptoms, the revised Psychopathy Checklist, and the Socialization scale of the California Psychological Inventory. The analysis yielded 6 replicable and temporally stable cluster groups varying in degree and pattern of antisociality. The groups were statistically compared on sets of external criterion variables--Addiction Severity Index measures of past and recent substance abuse and functioning and lifetime criminal history. Axis I and II symptomatology, anxiety and depression, object relations and reality testing, hostility, guilt, and machiavellianism. The expression of antisociality in the 6 groups and differences found among them on the external variables supported the validity of a more complex conceptualization of antisociality than is provided by antisocial personality disorder.

Adult↗
PubMed1998

The early course of change in methadone maintenance.

AIMS: This study examined the functional and substance use status of methadone maintenance (MM) patients at treatment entry and 2 and 7 months later. DESIGN: Two groups of subjects were identified for longitudinal follow-up, those in continuous MM treatment and those who left treatment. SETTING: The study was conducted at the Philadelphia Veterans Affairs Medical Center MM Program. PARTICIPANTS: Subjects were 157 men admitted to treatment. MEASUREMENTS: Change was evaluated using the Addiction Severity Index and urinalysis results. FINDINGS: Both groups of subjects reported significant reductions in drug use and increases in psychosocial functioning from admission to month 2, but demonstrated no significant changes from months 2 to 7. Subjects who left treatment, however, had more heroin use and criminal activity at all evaluation points than subjects who remained in treatment. Urinalysis data also suggested that subjects who left treatment were using drugs more frequently while in treatment than were those subjects who remained continuously enrolled in MM. Finally, subjects who left treatment spent more time in restricted environments (e.g. inpatient treatment, jail) at follow-up. CONCLUSIONS: Services may need to be enhanced to foster continuing progress in patients who remain in MM treatment and to retain those patients with more severe problems who leave treatment early.

Adult↗
PubMed1998

Gender differences in the relationship of antisocial personality disorder criteria to Psychopathy Checklist-Revised scores.

The relationship among adult, child, and full antisocial personality disorder (APD) criteria with the Psychopathy Checklist-Revised (PCL-R) (Hare, 1991) scores, an alternative to the Diagnostic and Statistical Manual of Mental Disorders' APD diagnosis, is examined in 395 men and 121 women substance abusers. Based on prior research, it was hypothesized that the correlations among childhood, adult, and full APD criteria and PCL-R Total, Factor 1 (Psychopathic Personality Traits), and Factor 2 (Antisocial Lifestyle) scores would differ for men and women. There was no difference between men and women in the correlations between full APD and PCL-R scores. Adult APD, however, had a stronger relationship to the Total and Factor 1 PCR-R scores in women compared to men, whereas child APD criteria were significantly related, although weakly, to Factor 1 scores for men, but not for women.

Adult↗
PubMed1998

A psychometric evaluation of the Defense Style Questionnaire in methadone patients.

The self-report Defense Style Questionnaire (DSQ) was designed to assess defenses along a developmental continuum. Factor analysis of the original DSQ suggested that the scale assessed four factors or types of defenses, whereas a more recent factor analysis indicated the DSQ measured three-factors: Immature, Neurotic, and Mature. No data, however, regarding the reliability or unique construct validity of DSQ dimensions was published. This article reports on factor analyses of two DSQ versions in a sample of 215 methadone maintenance patients. Results indicate that both DSQ versions are unidimensional, assessing only Immature defenses. The lack of published psychometric data raises concerns regarding the true reliability of DSQ dimensions reported in previous investigations. Prior statements based on DSQ findings may have been incorrect if the DSQ factors were unreliable. Findings from this investigation stress the importance of requiring and evaluating the psychometric integrity of an instrument before employing it in research.

Adult↗
PubMed1998

Long-term test-retest reliability of personality disorder diagnoses in opiate dependent patients.

This investigation reports the two year test-retest reliability of DSM-III-R personality disorder (PD) diagnoses in a sample of 219 patients with opiate dependence admitted to methadone treatment. Different MA/PhD interviewers at each assessment used a semistructured diagnostic interview for PD, the Structured Interview for DSM-III-R Personality Disorders (SIDP-R), to make their diagnoses. The reliability of any PD diagnosis versus no PD was fair (kappa = .51). The reliability for any specific PD (weighted kappa = .31) was poor. Antisocial (kappa = .45) and sadistic (kappa = .42), were the only specific PDs for which at least fair reliability was achieved. At the cluster level, only Cluster B had fair reliability (kappa = .47). The intraclass correlation coefficients between number of criteria for the specific PDs at the two evaluation points were consistently higher (range .22 to .62.) than were the corresponding kappas for categorical diagnoses. In that the base rates for most of the PDs were low and agreement for the specific PDs typically exceeded 90%. Increasing the base rate by lowering the diagnostic threshold, or examining more severe cases by raising the diagnostic threshold, did not consistently effect reliability. Reasons for the low kappa coefficients and the implications for PD research are discussed.

Adult↗
PubMed1998

Predictors of participation in aftercare sessions and self-help groups following completion of intensive outpatient treatment for substance abuse.

OBJECTIVE: The goals of this study were to identify predictors of greater participation in aftercare treatment sessions and self-help groups during the first 3 months following completion of a 4-week intensive outpatient rehabilitation (IOP) program. METHOD: The subjects were 138 male veterans who met DSM-III-R criteria for lifetime diagnoses of both alcohol and cocaine dependence (n = 67), alcohol dependence only (n = 48) or cocaine dependence only (n = 23); completed an IOP program; and expressed a desire to enter a formal aftercare program. Analyses examined relationships between predictor variables from five different domains and number of aftercare sessions and self-help groups attended in the last week of each month of the follow-up period. RESULTS: Of the many potential predictor variables that were examined, only remission from cocaine and alcohol dependence during IOP and higher AIDS risk behavior scores in the prior 6 months contributed independently to the prediction of greater participation in aftercare. Further analyses identified several variables that were differential predictors of participation in individualized relapse prevention aftercare versus standard 12-step focused group aftercare. More years of cocaine use, greater current legal problems and a lack of current alcohol dependence predicted greater self-help participation at the level of a trend. CONCLUSIONS: The achievement of remission from substance use dependence during IOP may be an important criterion for moving to the next level of care. However, the results of the present study also point to the need for an increased focus on factors present during the course of aftercare in future studies of retention in aftercare following outpatient rehabilitation.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Personality pathology and drinking in young men at high and low familial risk for alcoholism.

OBJECTIVE: Three groups varying in familial alcoholism risk were compared with respect to amount of alcohol consumption, presence of personality pathology, and the relationship between personality pathology and alcohol consumption. METHOD: Research subjects were young adult men recruited from local colleges, a trade school and the community. The risk groups included (1) a group with a biological alcoholic father and significant additional familial alcoholism (n = 106); (2) subjects with an alcoholic father, but without significant additional familial alcoholism (n = 100); and (3) a group with no paternal alcoholism and at most only one second/third-degree alcoholic relative (n = 190). Absolute daily ounces of alcohol was determined using a standard quantity-frequency scale. Prevalence of DSM-III-R personality disorders (PDs) was evaluated using the Personality Disorder Questionnaire-Revised both with and without application of an impairment and distress scale. Familial risk determination was based on agreement between four separate self-report assessments. RESULTS: The first group consumed significantly more alcohol than the other two groups, which did not differ in alcohol consumption. The first group's subjects were more likely to meet criteria for virtually all of the PD diagnoses than were the other two groups. A greater proportion of the second group's subjects qualified for various PDs than did the third group's subjects. Personality pathology was consistently or usually associated with more drinking in the first and third groups, respectively, but associated with less consumption in the second group. CONCLUSIONS: Young men with high-density familial alcoholism are at greater risk for the development of alcoholism than those with alcoholic fathers and little additional familial alcoholism. Relationships between personality pathology and alcohol consumption, and possibly the development of alcoholism, differ for the three risk groups.

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↗
PubMed1997

A cocaine-positive baseline urine predicts outpatient treatment attrition and failure to attain initial abstinence.

The primary study objective was to ascertain whether a prior finding that the baseline cocaine urine toxicology predicted treatment dropout for cocaine dependent outpatients could be extended to three additional cocaine dependent outpatient treatment samples and whether the urine toxicology also predicted attainment of initial abstinence for the four samples. A secondary objective was to ascertain the extent to which other baseline variables accounted for additional outcome variance over and above that afforded by urine toxicology. To evaluate the first objective, the relationships between the baseline cocaine urine and each of two measures of within treatment response--the completion of treatment or the attainment of initial abstinence--were determined for each of the treatment samples. The second objective was evaluated by a stepwise, hierarchical logistic regression analysis, with the urine toxicology entered in the first step, baseline Addiction Severity Index (ASI) variables in the second step, and achievement of initial abstinence as the outcome. In all four samples, patients with a urine indicative of recent cocaine use were less than half as likely to complete treatment or achieve initial abstinence. Individual ASI baseline variables did not contribute statistically significant variance over and above that predicted by the cocaine urine toxicology. The findings confirm the utility of the initial cocaine urine as a predictor of unfavorable outpatient treatment response.

Adult↗
PubMed1997

Validity of the psychopathy checklist-revised in male methadone patients.

The psychopathy checklist-revised (PCL-R) has been shown to be reliable when used with male methadone patients, but validity has not been established in this population. This paper examines the PCL-R's validity in 251 male methadone patients. Correlations between the PCL-R and background variables, Axis I and Axis II disorders, and several self report measures of related constructs are evaluated. Correlations with Axis I disorders were low except for substance dependencies, but strong correlations between Cluster B personality disorders were found. Results provide evidence of construct validity for the PCL-R, particularly total and Factor 2 scores, in male methadone patients.

Adolescent↗
PubMed1997

Group counseling versus individualized relapse prevention aftercare following intensive outpatient treatment for cocaine dependence: initial results.

Ninety-eight male cocaine-dependent patients who completed an intensive outpatient program (IOP) were randomly assigned to either standard group counseling (STND) or individualized relapse prevention (RP) aftercare. Heavier cocaine and alcohol use during IOP and low self-efficacy predicted more cocaine use during the treatment phase of the study, whereas lifetime diagnoses of alcohol dependence, major depression, and any anxiety disorder predicted less cocaine use. Rates of complete abstinence during the 6-month study period were higher in STND than RP, whereas RP was more effective in limiting the extent of cocaine use in those who used during Months 1-3. Matching analyses indicated patients who failed to achieve remission from cocaine dependence during IOP and those with a commitment to absolute abstinence did better in RP than in STND, whereas patients with other abstinence goals did better in STND than RP. Several differences in experiences before cocaine use and "near-miss" episodes were also identified.

Adult↗
PubMed1997

An initial evaluation of the psychosocial dimensions of the American Society of Addiction Medicine criteria for inpatient versus intensive outpatient substance abuse rehabilitation.

OBJECTIVE: The American Society of Addiction Medicine (ASAM) criteria were developed as guidelines for the placement of substance abuse patients in appropriate levels of care. Although the ASAM criteria are widely used, little is known about their validity. In this study, we evaluated the predictive validity of the psychosocial dimensions of the ASAM criteria for inpatient versus intensive outpatient rehabilitation. METHOD: The psychosocial dimensions of the ASAM criteria were first operationalized with instruments with proven reliability and validity. The criteria were then used to determine whether cocaine (n = 159) and alcohol (n = 133) dependent male patients in inpatient and intensive outpatient rehabilitation programs were correctly "matched" to the level of care they received. The patients were followed up at 3, 6 and 12 months postrehabilitation, and outcomes of "matched" and "mismatched" patients were compared in a number of ways. RESULTS: Alcohol and cocaine patients who were correctly matched to treatment according to ASAM did not have significantly better outcomes than those who were mismatched. Furthermore, a more focused analysis generated no evidence that alcohol patients who met ASAM criteria for inpatient care had better outcomes in that setting than in intensive outpatient treatment. Among cocaine patients who met ASAM inpatient criteria, inpatient care produced marginally better short-term outcomes on most measures, although these results did not reach statistical significance. CONCLUSIONS: These results suggest that the psychosocial dimensions of the ASAM criteria for inpatient treatment are probably too broad and are therefore in need of further refinement, particularly for alcohol patients. However, all patients were male veterans without acute medical problems serious enough to warrant inpatient care or histories of psychosis, and the majority were of lower socioeconomic status. It is not clear to what extent the results would generalize to substance abusers with other characteristics.

Adult↗
PubMed1997

The Addiction Severity Index in clinical efficacy trials of medications for cocaine dependence.

In sum, the ASI provides a standard and multidimensional initial evaluation of the subject. Furthermore, a profile of subjects is obtained that can be compared at different evaluation points, providing secondary outcomes. However, for the purposes of clinical trials evaluating pharmacotherapy for cocaine abusers, supplemental measures are needed at both baseline and followup to more specifically address cocaine use and problems.

Cocaine↗
PubMed1996

Development of the cocaine relapse interview: an initial report.

Although fine-grained analyses of circumstances surrounding relapses have been conducted with alcoholics, smokers and opiate users, there is comparatively little information about the relapse process in cocaine abusers. The Cocaine Relapse Interview (CRI) is a structured interview that gathers information on the onset, course and termination of cocaine relapse episodes. This article describes the development of the CRI and presents initial data on its reliability and validity. Sections of the CRI assess experiences on the day of the relapse, experiences during the week prior to the relapse, attributions for the relapse, experiences following initial use of cocaine and factors in terminating the relapse. Most of the subscales in each section of the CRI had adequate internal consistency and test-retest reliabilities. Validity studies indicated that most of the subscales that assess experiences prior to relapse differentiated relapsers from two control groups of non-relapsers, and that several subscales and individual items from the sections that assess experiences following initial use and factors in termination differentiated "lapsers" from "relapsers". Limitations of the CRI and recommendations for its use were also discussed.

Adult↗
PubMed1996

Personality disorders and treatment outcome in methadone maintenance patients.

This study examined the relationship between personality disorder (PDs) and 7-month treatment outcome in 197 men admitted to methadone maintenance. Subjects reported pervasive improvement, and the amount of improvement did not significantly differ for those subjects with and without PDs. PD subjects entered treatment with more severe self-reported drug, alcohol, psychiatric, and legal problems, and despite progress, remained more problematic in those areas relative to subjects without PDs. Subjects with antisocial PD had admission and 7-month problem status similar to subjects with other PDs. The 7-month urinalysis results for opiates and cocaine showed no significant differences between subjects with and without PDs. Fewer PD subjects stayed in treatment continuously for the 7-month period. Several cluster B PDs-borderline, antisocial, and histrionic-predicted poorest overall outcomes. Methadone-maintained patients with PDs may warrant additional treatment services if they are to approach the functional level of patients without PDs.

Adult↗
PubMed1996

Evidence for response set effects in structured research interviews.

The Addiction Severity Index and NIMH Diagnostic Interview Schedule data of 20 methadone-maintained subjects with "fake bad" invalid profiles on the Personality Assessment Inventory, 15 methadone-maintained subjects with "fake good" invalid profiles, and 158 methadone-maintained subjects with valid profiles were compared. The findings revealed a number of significant group differences on both measures with the highest scores for the fake bad subjects and lowest scores for the fake good subjects. These findings suggest that the response sets exhibited in response to the Personality Assessment Inventory questionnaire extended to performance during the two semi-structured interviews. There was no indication that interviewers were aware of misrepresentation. The limitations of the findings and alternative interpretations of the data are considered.

Adult↗
PubMed1996

Gender differences in the relapse experiences of cocaine patients.

This study investigated potential gender differences in the onset, course, and termination of cocaine relapse episodes. The subjects were 98 cocaine dependent men and women who were participating in several treatment outcome studies. The Cocaine Relapse Interview was used to obtain data on specific relapse episodes that had occurred in a 6-month period before the interview. The analyses indicted that women reported more unpleasant affect and interpersonal problems and fewer positive experiences before relapse than men, and their relapses were more likely to have an impulsive quality. Women reported more help-seeking after initial use, whereas men reported stronger appetitive reactions and more self-justification. There were no gender differences in factors associated with terminating the relapse episodes. Clinical implications and limitations of the research are discussed.

Adolescent↗