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J S Cacciola

Publications and source records attributed to J S Cacciola.

49 records · Page 3Linked to original sources
PubMed1996

Response to methadone maintenance and counseling in antisocial patients with and without major depression.

This study compared the treatment response of four groups of psychiatrically diverse opiate-dependent, methadone maintenance patients receiving drug counseling. The four groups were patients with no other nonsubstance abuse axis I psychiatric diagnoses (OP only; N = 65), patients with lifetime major depression (DEP; N = 60), patients with both antisocial personality disorder and lifetime major depression (APD + DEP; N = 35), and patients with only APD (APD only; N = 24). Patients were assessed at intake, during treatment, and 7 months after treatment admission. No statistically significant differences were found among the groups in treatment retention/attendance. Few significant group differences were revealed during-treatment urine screens, except that barbiturate use was more common for the APD only group. The APD only group also had significantly more positive urine screens for benzodiazepines than the other three groups at 7-month follow-up. All groups reported considerable improvement in problem level at 7 months compared with admission status. The APD only group reported fewer gains in legal and employment problems than the other groups but reported greater improvement in the drug area. Thus, there was some limited support for a prior finding, based on individual psychotherapy, that the treatment response of APD only patients was inferior to that of APD + DEP patients or non-APD patients.

Antisocial Personality Disorder↗
PubMed1996

Assessment of object relations and reality testing in methadone patients.

OBJECTIVE: The authors studied methadone maintenance patients to determine the degree of their impairment in object relations and reality testing and the relationship of such impairment to comorbid axis I and axis II disorders. It was expected that deficits in object relations and, to a lesser degree, reality testing would be exhibited by the group as a whole and that they would be related to the presence of comorbid disorders. METHOD: The self-report Bell Object Relations Reality Testing Inventory was administered to 240 methadone maintenance patients. The subjects were first divided into groups on the basis of number of comorbid axis I disorders and then on the basis of number of comorbid axis II disorders. Finally, the subjects were placed into one of four groups on the basis of the combined presence or absence of axis I and axis II disorders. RESULTS: The methadone patients exhibited some specific impairments in object relations, but not in reality testing. Bell inventory scores did not significantly differ according to the number of comorbid axis I disorders, but they did significantly differ according to number of axis II disorders diagnosed. The scores were poorest for those with axis II disorders only, while subjects with only axis I disorders had scores similar to those with neither axis I nor II disorders. CONCLUSIONS: Comorbid axis II disorders, more than axis I disorders, may be associated with problems in object relations and reality testing in methadone patients.

Adult↗
PubMed1995

An examination of the cocaine relapse process.

Although empirical studies of the relapse process have been done with alcoholics, smokers, and opiate addicts, comparatively little information is available on the relapse process in cocaine abusers. This paper presents data from the Cocaine Relapse Interview (CRI), a structured interview that assesses factors associated with the onset, course, and termination of cocaine relapse episodes. In a sample of 95 cocaine dependent patients, the experiences that occurred with the greatest frequency immediately prior to relapse were wanting drugs, being alone, having money, and feeling extremely bored and lonely. Following the onset of the relapse, the most frequent experience was unpleasant affect, although positive reactions were also relatively common. The factors perceived as most important in terminating relapse were painful internal states, help-seeking behaviors, and other coping responses. Three types of relapse experiences, or pathways, were identified: (a) unpleasant affect--painful internal states prior to and throughout the relapse; (b) positive affect--positive affect and pleasant social experiences prior to relapse coupled with a relatively unproblematic course; and (c) sensation seeking--sensation seeking and interpersonal problems prior to relapse coupled with mixed emotional reactions and antisocial behavior during the relapse, and interpersonal problems at relapse termination.

Adult↗
PubMed1995

Treatment response of antisocial substance abusers.

We evaluated the relationship of antisociality to 7-month treatment response in 224 alcohol-and/or cocaine-dependent men. Subjects with and without a DSM-III antisocial personality disorder (ASPD) responded similarly and positively to treatment in a number of functional domains, including substance use. A more detailed analysis comparing subjects with ASPD, subjects meeting adult but not childhood ASPD criteria (A-ASPD), and subjects meeting neither adult nor childhood ASPD criteria (pure non-ASPD) revealed similar and positive responses to treatment among the three groups. The antisocial groups had more cocaine and alcohol use at the baseline evaluation, but at 7-month follow-up, they had levels of use not significantly different than the pure non-ASPD group. The findings suggest that an ASPD diagnosis or an adult antisocial lifestyle, at least as measured by DSM-III criteria, does not predict short-term treatment response.

Adult↗
PubMed1995

Gender differences in diagnosing antisocial personality disorder in methadone patients.

OBJECTIVE: The goal of this study was to evaluate gender differences in the prevalence rates, short-term reliability, and internal consistency of the diagnosis of antisocial personality disorder for DSM-III-R, DSM-III, and Research Diagnostic Criteria (RDC). METHOD: A total of 37 men and 57 women methadone patients were diagnosed according to DSM-III-R, DSM-III, and RDC antisocial personality disorder criteria. RESULTS: The diagnostic rates, reliability, and internal consistency were lower for women than for men in all systems. DSM-III criteria resulted in the highest reliability for women, but for men, the DSM-III criteria were the least reliable. Examination of endorsement rates of individual antisocial personality disorder criteria revealed several significant gender differences on the majority of childhood criteria and on several adult criteria. Item-total correlations revealed that for women, the violent and aggressive childhood criteria in DSM-III-R that had not been included in DSM-III or RDC had a negative or no correlation to the assessment of antisocial personality disorder for women. CONCLUSIONS: The change in DSM-III-R from DSM-III childhood criteria appears to have resulted in a decrease in internal consistency and rates of antisocial personality disorder for women, but not for men. The results of this investigation indicate that the psychometric properties of the current antisocial personality disorder scales are weak for women, compared with men. To assess antisocial personality disorder in women it may be necessary to revise current, or develop new, diagnostic criteria.

Antisocial Personality Disorder↗
PubMed1994

Relationships of personality disorders with problem severity in methadone patients.

The prevalence of DSM-III-R personality disorders were assessed in a sample of 179 male methadone maintained opiate addicts. The discriminant validity of three personality disorder (PD) groupings were compared with respect to Axis I disorders, functioning in a number of important life areas, risk for HIV infection, and social judgment/sensitivity. Results showed that a PD, regardless of the number or type, identified patients with more employment, family/social, and psychiatric problems, increased risk for HIV infection, and poor social judgment/sensitivity. Few differences were revealed when three clusters of PDs (Cluster A, B, and C) were compared. With few exceptions, subjects with antisocial PD were no worse off than those with any other PD with respect to current functioning.

Adolescent↗
PubMed1994

An examination of the diagnostic criteria for antisocial personality disorder in substance abusers.

In this article, we compare problem severity and adult antisocial behavior among three groups of cocaine- or alcohol-dependent patients: those with antisocial personality disorder (APD), those who met adult but not childhood APD criteria (A-APD), and those who met neither (non-APD) in order to determine the clinical utility of the A-APD category. Subjects were 269 male veterans admitted for substance abuse treatment. The Addiction Severity Index was used to determine problem severity and the NIMH Diagnostic Interview Schedule was used to obtain positive DSM-III APD criteria and APD diagnoses. More APD subjects reported arrests, illegal behavior, and chronic lying than A-APD and non-APD subjects. On several variables (recent family/social problems, trouble controlling violent behavior, and time incarcerated), A-APD subjects were intermediate in severity. Overall, the non-APD subjects had the least severe problem status. When the APD and A-APD groups were equated on number of positive adult APD criteria, the only differences that consistently remained were difficulty controlling violent behavior and commission of criminal acts, which were endorsed more frequently in the APD group. It appears that the unique contribution of the early onset criteria for the APD diagnosis is that it identifies individuals more likely to engage in criminal and violent behavior. The more general irresponsibility and disregard for the rights of others characteristic of APD is equally evident in both antisocial groups. This work indicates that the APD versus non-APD distinction may not be fine grained enough for clinical or research purposes.

Adult↗
PubMed1993

Addiction Severity Index scores of four racial/ethnic and gender groups of methadone maintenance patients.

This report compares the findings for four racial/ethnic and gender groups of methadone maintenance (MM) patients--African-American men (n = 153), African-American women (n = 107), Hispanic men (n = 138), and Hispanic women (n = 70)--administered the Addiction Severity Index (ASI). African-American men had a history of more arrests and incarcerations than Hispanic men. African-Americans had a longer history of drug and alcohol abuse problems than Hispanics and more current alcohol problems. Women reported more medical, psychiatric, family-social, and employment problems than men. Men reported more legal and alcohol-related problems than women. With several exceptions, the study findings were consistent with those based on other instruments. Given the relatively large sample sizes, the data may provide a characteristic ASI profile of the racial/ethnic and gender groups studied. The implications of differential group problem levels for substance abuse treatment efforts are discussed.

Adult↗
PubMed1991

The antisocial personality disorder diagnosis in substance abusers: problems and issues.

This paper examines the question of whether antisocial personality disorder (APD) can be considered a viable substance abuse typology. The data for APD substance abusers are first reviewed with respect to six properties that apply to establishing the validity of a clinical typology. This is followed by a brief description of the historical context and development of current conceptualizations of antisocial personality. Some possible sources of diagnostic unreliability and instability that could serve to limit the validity of the APD diagnosis are then discussed. Finally, evidence indicating considerable psychiatric heterogeneity within APD substance abusers is described. The findings indicate that although APD substance abusers satisfy many of the criteria for a clinical subtype, the fit is sufficiently imprecise to suggest the need for further refinement. We attempt to point out some of the critical questions, issues, and lines of research that could help to guide future efforts to clarify, refine, and revise the APD formulation, particularly as it applies to substance abusers.

Alcoholism↗
PubMedDate not supplied

The relationship of object relations and reality testing deficits to outcome status of methadone maintenance patients.

Impairments in the ability to form and maintain meaningful interpersonal relationships and in the ability to distinguish between internal and external stimuli are related to an individual's psychological health. The Bell Object Relations and Reality Testing Inventory (BORRTI) scores of 146 methadone patients were used to evaluate whether transitory (TI) or chronic impairments (CIs) in object relations and reality testing were related to more severe drug use, family and social problems, psychological distress, as well as more time in treatment, seeking additional treatments, or taking psychiatric medication. The results showed no significant relationship between BORRTI scores and family or social problems, time in treatment, or the months of heroin use between follow-up evaluations. However, severity of drug use was related to an impairment in a specific dimension of object relations-egocentricity. There was a significant relationship between TIs and CIs in object relations and reality testing with levels of psychological distress and the likelihood of taking psychiatric medication.

Adult↗
PubMedDate not supplied

Social competence in opiate-addicted individuals: gender differences, relationship to psychiatric diagnoses, and treatment response.

Only one prior study has examined social competence (SC) in drug addicted individuals. That study of cocaine-addicted individuals found gender differences in SC as well as differences based on the type of comorbid psychiatric diagnoses given. This study attempts to replicate findings from that cocaine study in a sample of opiate-addicted individuals and explores the relationship of SC to short-term treatment response. Gender differences in SC were examined in 28 women and 44 men attending a community methadone maintenance program. The question of differences in SC based on comorbid psychiatric diagnoses and treatment response were examined in a sample of 198 men attending a Veterans Administration methadone program. Women were found to have significantly lower SC than men. No significant differences in SC were revealed based on the presence of specific psychiatric diagnoses. SC was not related to short-term treatment response.

Adult↗
PubMedDate not supplied

The use of case vignettes for Addiction Severity Index training.

In an attempt to enhance the reliability of Addiction Severity Index (ASI) interviewer severity ratings (ISRs), we developed a set of eight ASI vignettes, fictionalized narrative case summaries that reproduced the quantitative ASI information in case report format. Each vignette has an ISR answer key, a consensus ISR of two expert ASI trainers for each problem area. Additionally, for four of the vignettes the rationale for the correct ISRs was operationalized. This report is a description of the ASI vignette packet, its use as a supplement to standard ASI training and the results of a pilot study to gauge its effectiveness in improving criterion validity of ISRs. Five ASI videotapes were also developed for the purposes of this investigation. There was limited evidence in this preliminary investigation that the addition of the ASI vignette packet to standard ASI training increased agreement with expert consensus ISRs. The ASI vignettes, relative to videotaped or live observed interviews, do however provide a brief means of assessing the adequacy of ASI interviewer skills with regard to ISRs.

Humans↗