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Biomedical subjects

M D Anglin

Publications and source records attributed to M D Anglin.

At least 109 records · Page 6Linked to original sources
PubMed1981

Shutting off methadone. Costs and benefits.

We report the findings of a two-year follow-up of the 99 methadone clients enrolled in the Bakersfield, Calif, clinic when it was closed in September 1976. Because of the remote location, only 11 transferred to another clinic. A sample of 88 were selected from a continuing program for comparison. Ninety-five percent of the combined samples were interviewed. Fifty-four percent of the terminated clients became readdicted to heroin, and the arrest and incarceration rates were approximately double that for the comparison sample. The simultaneous initiation of a special police narcotic task force may have contributed to the arrest rate and limited the percent of time addicted. The net economic costs subsequent to discharge were slightly less than that for the comparison group; however, when the benefits resulting from new admissions are considered, the clinic closing represented an economic loss in addition to the detrimental effects experienced by the clients.

Cost-Benefit Analysis↗
PubMed1981

Long-term follow-up of clients of high- and low-dose methadone programs.

A six- to seven-year follow-up of 1971-1973 admissions to three methadone hydrochloride maintenance programs was conducted. Ninety percent of those alive were interviewed. Two of the programs used a high-dose, long-retention policy, while the third used low doses and a relatively strict policy with respect to involuntary termination for program violations. Retention was much longer for the two high-dose programs, and during the six to seven-year periods from program entry to interview, the clients had significantly less arrest, incarceration, narcotic addiction, and self-reported criminal behavior than did the patients in the low-dose program. These advantages persisted until the time of interview and existed for periods with as well as without methadone. In addition, the overall social costs in the high-dose programs were substantially less than in the low-dose program.

Age Factors↗
PubMed1981

The effect of parole on methadone patient behavior.

A 7-year followup of three male samples of 1971-1973 methadone maintenance admissions was conducted: a random sample of 100; a sample of 136 who had a minimum of 30 months remaining on civil addict parole status at the time of methadone entry; and a matched sample of 136 not on parole. Ninety percent of those not decreased were interviewed. The overall sample spent 58% of the nonincarcerated follow-up interval on methadone. This resulted in a large decline in daily heroin use and associated criminal behavior measures. The addition of parole supervision with urine testing resulted in only marginal improvements in behavior over that attributable to maintenance alone; however, the parole status did significantly reduce the length of intervals of daily heroin use both prior and subsequent to methadone entry.

Adult↗
PubMed1977

A follow-up of admissions to the California Civil Addict Program.

A follow-up interview study of early admissions to the California Civil Addict Program found that those continuing in the program performed substantially better during the commitment period than did a comparable group discharged shortly after admission. To a lesser extent, the program also appeared to have had some impact subsequent to discharge. Those program discharges defined as successes tended to do relatively well until the time of interview. Comparisons under the strict (pre-1970) and more lenient regimens showed roughly comparable behavior, but the availability of methadone maintenance was also a significant factor in reducing heroin use during the latter period.

Adult↗
PubMedDate not supplied

Variations in psychosocial functioning associated with patterns of progression in cocaine-dependent men.

This study examined the relationship between patterns of progression of cocaine use and psychosocial functioning in a sample of cocaine-dependent men who were veterans. Four patterns of progression were examined: mild-severe, moderate-severe, mild-moderate-severe, and severe only. Analysis of variance and post hoc analysis with Duncan grouping revealed significant differences among cocaine users with different patterns of progression in terms of negativism, problem index for situations involving unpleasant emotions, problem index for situations involving urges, depression, somatic anxiety, and medical problems in the family. However, there were no significant differences on sensation seeking, confidence to resist taking cocaine in different situations, obsessive compulsiveness, somatization, attention deficit, and social adjustment. Cocaine users with a severe-only pattern of progression were significantly more dysfunctional than those with mild-moderate-severe progression in terms of negativism, problem index for situations involving unpleasant emotions, depression, and somatic anxiety. Cocaine users with mild-moderate-severe progression had significantly less somatic anxiety than those with mild-severe progression and had less negativism and a lower problem index for urges than those with moderate-severe progression. Logistic regression analysis revealed unique behavioral variables associated with different patterns of progression. The implications of these findings for treatment are discussed.

Adaptation, Psychological↗
PubMedDate not supplied

What happens when a demonstration project ends. Consequences for a clinic and its clients.

The Los Angeles Enhanced Methadone Maintenance Project was a 5-year research demonstration project funded by the National Institute on Drug Abuse with the goal of reducing high-risk behavior for human immunodeficiency virus (HIV) among heroin users. A clinic was established for the purposes of the study and 500 clients with high-risk profiles were recruited into treatment. Follow-up assessments demonstrated that clients had reduced their drug use, criminal behavior, and HIV-risk behaviors after entering treatment. At the end of the project clients were given the option of continuing treatment at the clinic on a fee-for-service basis, transferring to another treatment provider, or undergoing detoxification. Clients who were eligible for Medicaid were likely to continue receiving methadone treatment, but those without Medicaid funding were not. The implications of terminating treatment among a high-risk population recruited into a research demonstration project are discussed.

Adult↗
PubMedDate not supplied

More is better: counseling participation and the effectiveness of outpatient drug treatment.

Counseling is a cornerstone of virtually all drug treatment modalities, yet there is relatively little research examining counseling effectiveness. This article addresses a simple question concerning counseling: Is more frequent participation in counseling associated with better treatment outcomes? Findings from an evaluation of the Los Angeles Target Cities Project indicate that monthly counseling frequency varied substantially for participants of outpatient programs, and more frequent counseling was associated with lower levels of relapse to drug use, even for individuals who successfully completed the treatment program. The association between counseling frequency and relapse did not attend to all types of counseling, however, but mainly to group and individual counseling. More frequent attendance of family counseling and 12-step meetings during the outpatient treatment phase did not significantly lower the probability of relapse. Frequent participants of group and individual counseling who continued to be frequent participants of 12-step meetings during the posttreatment period had the lowest probability of relapse. The policy implications of the findings and directions for further research are discussed.

Adolescent↗
PubMedDate not supplied

Drug treatment careers. A conceptual framework and existing research findings.

While outcomes for any single intervention are important to determine, the long term evaluation of multiple, sequential interventions is at least equally important. One strategy for examining this process is that of the treatment career. A treatment careers perspective applies a longitudinal dynamic approach to identify and understand key factors influencing the development of, and transitions in the course of, drug dependence and its treatment. After presenting an overview of the treatment careers perspective, this paper reviews and discusses relevant research issues and findings on treatment seeking, utilization and resistance, entry and reentry, engagement and retention, client treatment matching, and outcomes. Key findings include high resistance to entering treatment by many drug users, late development of treatment careers relative to addiction and criminal careers, short durations of most treatment episodes, cumulative and facilitative effects of treatment experiences, and beneficial effects of matching clients to treatment. The treatment careers perspective provides a useful framework within which findings on drug treatment can be better integrated and critical issues can be identified for further research, leading to a better understanding of drug dependence and its treatment.

Chronic Disease↗
PubMedDate not supplied

Predicting drug treatment entry among treatment-seeking individuals.

This study examined factors related to drug treatment program entry among 276 drug abusers seeking treatment referral. Six-month follow-up interviews determined that 171 (62.0%) followed through with the treatment referral. The analyses indicated that treatment-entry and non-entry subjects did not differ in predisposing factors (age, gender, race/ethnicity, education), type of drug use, or years of use. A logistic regression analysis indicated that characteristics at baseline predicting subsequent treatment entry include legal pressure, lower levels of psychological distress and family or social problems, and prior successful treatment experience. Legal coercion was an effective factor promoting treatment entry. Drug abusers having prior successful treatment experience were also more likely to reenter treatment. However, those with more severe problems (drug related and others) seemed less likely to enter treatment, indicating that psychological distress and family problems may undermine motivation to follow through on treatment referral.

Adult↗
PubMedDate not supplied

Comparative treatment effectiveness. Effects of program modality and client drug dependence history on drug use reduction.

This study examined treatment outcome as a function of program modality, clients' lifetime patterns of drug dependence, and their interaction, controlling for current level of drug use at treatment intake. Data were based on 2,966 clients who were interviewed at intake and at 1-year follow-up as part of the Drug Abuse Treatment Outcome Study (DATOS), which included programs of four major modalities. Subjects' lifetime patterns of drug dependence were classified into nine groups according to Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric Association; 1987) diagnostic criteria and time of onset of drug use career. Outcome measure was the reduction of heroin use or cocaine use at follow-up from levels at intake. The results showed that rates of lifetime drug dependence and current drug use at DATOS admission were highest among methadone maintenance clients and lowest among outpatient drug-free clients. Drug use reduction was observed for all modalities. The presence of dependence diagnosis was associated with less improvement when current use level at intake was controlled. Clients dependent on heroin but not currently daily users benefited most from inpatient and residential programs. Methadone programs were also relatively ineffective in reducing cocaine use. Characteristics of the client's drug dependence history, in addition to the current or presenting drug problem, should be assessed to guide treatment planning. The high rate of cocaine dependence among methadone clients, most of whom were dependent on heroin, poses considerable challenge to contemporary opiate substitution treatments.

Adult↗
PubMedDate not supplied

Sexual and physical abuse: do they compromise drug treatment outcomes?

Histories of sexual and physical abuse are frequently reported by individuals participating in substance abuse treatment, these experiences may be associated with psychopathology and poor drug treatment outcomes. This paper presents the findings from a longitudinal study of 330 subjects participating in 26 outpatient treatment programs. Sexual abuse among women was associated with higher levels of depression, anxiety, suicidal ideation, suicide attempts, and PTSD, while physical abuse was associated with fewer psychological disturbances. For men, sexual abuse was associated only with anxiety. Physical abuse was associated with depression, anxiety, suicidal ideation, and PTSD. However, no significant association was found between sexual and physical abuse, and lower levels of treatment participation or drug use at follow-up. These findings indicate that there is a complex connection between abuse, psychopathology, treatment participation, and relapse. Clinical and research implications of these findings are discussed.

Adolescent↗
PubMedDate not supplied

Reasons for discharge from methadone maintenance for addicts at high risk of HIV infection or transmission.

This article reports on a methadone maintenance program that had the goal of retaining in treatment heroin addicts at high risk of HIV infection and/or transmission. Subjects were recruited from four-high-risk target groups and randomly assigned to either an enhanced or standard methadone maintenance group. The analysis examined predictors of any type of discharge, negative discharge, and circumstantial discharge. Discharge for any reason was more likely for younger individuals, sex industry workers, and high-risk sex partners. Legal supervision at intake and coercion into treatment reduced the probability of discharge for any reason. HIV-positive individuals were more likely to discharge for circumstantial reasons than negative reasons. The probability of circumstantial discharge was increased for males, individuals reporting suicidal ideation, and those scoring higher on an impulse expression scale. The likelihood of circumstantial discharge was decreased for individuals who reported more sources of legal income or who lived someone using illegal drugs. Participation in the enhanced treatment group appeared to reduce the probability of negative, compared with circumstantial, discharge. The findings should assist methadone treatment providers in targeting individuals at high probability of discharge for special efforts to increase treatment retention and to reengage them back into treatment after discharge, as part of a harm-reduction strategy to minimize risks of HIV infection and/or transmission.

Adult↗
PubMedDate not supplied

Perceived need for treatment among pregnant and nonpregnant women arrestees.

Previous research has noted a high rate of drug use by women arrestees. Not only are women arrestees more likely to be found drug positive by urinalysis than are men arrestees, but in recent years, in part because of drug use, women have constituted the fastest growing population segment involved with the criminal justice system. One small but important subgroup of women arrestees are those who are pregnant and, thus, who particularly need intervention. This article utilizes Drug Use Forecasting (DUF) data from Los Angeles jails to examine whether or not pregnant drug-abusing women arrestees differ from nonpregnant drug-abusing women arrestees in terms of perceived need for treatment. Bivariate analyses and multivariate logistic regression show that pregnant drug-using women are not more likely than nonpregnant women to perceive a need for treatment. Although pregnancy status is not related to perceived need, a number of other factors are related, including being single, Euro-American ethnicity, using cocaine or opioids for more than three days in the past 30 days, being self-identified as currently drug dependent, having a substance abuse treatment history, and having lower legal incomes. Interventions with drug-using women arrestees should be made early in their drug use and criminal careers and should target both pregnant and nonpregnant women.

Adolescent↗