Clinical treatment of opioid addiction and dependence.
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Administration, Oral↗
Biomedical subjects
Richard A Rawson
Publications and source records attributed to Richard A Rawson.
Predicting treatment success at multiple timepoints in diverse patient populations of cocaine-dependent individuals.
The quest for predictive utility of baseline demographic and drug use characteristics has been difficult. The present article draws data from two studies of cocaine-dependent individuals (N = 297) in treatment at clinics in Los Angeles, and examines the utility of socio-demographic characteristics of patients and in-treatment performance variables as predictors of success at treatment end, 6 and 12 month follow-up assessments. Socio-demographic variables examined are age, gender, ethnicity, and educational attainment; drug use variables include years of cocaine use, self-reported days of cocaine use, the Addiction Severity Index drug composite score, and two composite measures cited in the literature. The in-treatment variables examined include cocaine urine toxicology results, number of weeks retained, and measures of compliance. The self-reported number of days of cocaine use in the past 30 days provides the most predictive utility of all baseline variables evaluated, and is the most parsimonious of the significant variables associated with substance use at all subsequent timepoints. Matching cocaine-dependent patients with treatment types or intensities based on the self-reported number of cocaine use days at intake may increase patient success rates.
Adult↗
A comparison of contingency management and cognitive-behavioral approaches during methadone maintenance treatment for cocaine dependence.
BACKGROUND: This study compared 2 psychosocial approaches for the treatment of cocaine dependence: contingency management (CM) and cognitive-behavioral therapy (CBT). METHODS: Patients with cocaine dependence who were receiving methadone maintenance treatment (n = 120) were randomly assigned to 1 of 4 conditions: CM, CBT, combined CM and CBT (CBT + CM), or treatment as usual (ie, methadone maintenance treatment program only [MMTP only]) (n = 30 per cell). The CM procedures and CBT materials were comparable to those used in previously published research. The active study period was 16 weeks, requiring 3 clinic visits per week. Participants were evaluated during treatment and at 17, 26, and 52 weeks after admission. RESULTS: Urinalysis results during the 16-week treatment period show that participants assigned to the 2 groups featuring CM had significantly superior in-treatment urinalysis results, whereas urinalysis results from participants in the CBT group were not significantly different than those from the MMTP-only group. At week 17, self-reported days of cocaine use were significantly reduced from baseline levels for all 3 treatment groups but not for the MMTP-only group. At the 26-week and 52-week follow-up points, CBT participants showed substantial improvement, resulting in equivalent performance with the CM groups as indicated by both urinalysis and self-reported cocaine use data. CONCLUSIONS: Study findings provide solid evidence of efficacy for CM and CBT. Although the effect of CM is significantly greater during treatment, CBT appears to produce comparable long-term outcomes. There was no evidence of an additive effect for the 2 treatments in the CM + CBT group.
Adult↗
Drugs and sexual effects: role of drug type and gender.
This study investigated gender differences in the relationship between psychoactive substance use and sexual thoughts, feelings, and behaviors. Participants (N = 464) were male and female alcohol, opiate, cocaine, and methamphetamine users enrolled in an outpatient treatment program at any of 8 sites. A self-report survey that inquired about the specific sexual thoughts, feelings, and behaviors of the participant during previous instances of being under the influence of their primary drug of dependence served as the data source. The results indicate that different categories of psychoactive agents were associated with different effects on sexual behavior, and that those effects vary by gender. Development of a valid measure assessing the type and strength of these relationships may be beneficial for use by treatment programs in promoting abstinence from drug and alcohol use and preventing relapse.
Adult↗
Treatment of methamphetamine use disorders: an update.
Methamphetamine (MA) is a major public health and criminal justice problem in much of the Western and Midwestern US, and its use seems to be increasing east of the Mississippi River. MA use can produce significant psychiatric and medical consequences, including psychosis, dependence, overdose, and death. Cognitive behavioral therapy and contingency management are among the most promising approaches for treatment of MA abuse and dependence. A multisite study evaluating the Matrix Model of outpatient treatment will soon be completed to provide data on this manualized approach. An ambitious program of pharmacotherapy development research is currently being sponsored by the National Institute on Drug Abuse (NIDA) in geographic areas significantly affected by MA use. The development of treatments for MA-related problems is particularly critical for a number of user groups including MA users who experience persistent psychosis, pregnant women and women with children, gay and bisexual men, and MA users involved in the criminal justice system.
Amphetamine-Related Disorders↗
Incorporating brain research findings into standard treatment: an example using the Matrix Model.
One way to promote the goal of broadening the application of research to applied treatment is through the development and dissemination of empirically supported clinical treatment manuals. NIDA and NIAAA have published a series of manuals that delineate specific psychotherapies and/or behavioral approaches designed for the treatment of drug and alcohol abuse. This article describes a manualized treatment approach, the Matrix Model, which incorporates several of these psychosocial interventions with some basic explanations of recent brain research to form a comprehensive, multi-component model of outpatient stimulant abuse treatment. A large multi-site trial sponsored by CSAT compares the Matrix Model of outpatient treatment with treatment as usual in 7 sites where methamphetamine is a significant problem. The translation and adaptation of the Matrix manual for cocaine users in Mexico and methamphetamine users in Thailand will offer opportunities to evaluate this approach with very diverse populations of stimulant users.
Humans↗
Smoking cessation in methadone maintenance.
AIMS: To evaluate relapse prevention (relapse prevention) and contingency management (contingency management) for optimizing smoking cessation outcomes using nicotine replacement therapy for methadone-maintained tobacco smokers. DESIGN: Experimental, 2 (relapse prevention)x2 (contingency management) repeated measures design using a platform of nicotine replacement therapy featuring a 2-week baseline period, followed by randomization to 12 weeks of treatment, and 6- and 12-month follow-up visits. SETTING: Three narcotic treatment centers in Los Angeles. PARTICIPANTS: One hundred and seventy-five participants who met all inclusion and no exclusion criteria. INTERVENTION: Participants received 12 weeks of nicotine replacement therapy and assignment to one of four conditions: patch-only, relapse prevention + patch, contingency management + patch and relapse prevention + contingency management + patch. MEASUREMENTS: Thrice weekly samples of breath (analyzed for carbon monoxide) and urine (analyzed for metabolites of opiates and cocaine) and weekly self-reported numbers of cigarettes smoked. FINDINGS: Participants (73.1%) completed 12 weeks of treatment. During treatment, those assigned to receive contingency management showed statistically higher rates of smoking abstinence than those not assigned to receive contingencies (F3,4680=6.3, P=0.0003), with no similar effect observed for relapse prevention. At follow-up evaluations, there were no significant differences between conditions. Participants provided more opiate and cocaine-free urines during weeks when they met criteria for smoking abstinence than during weeks when they did not meet these criteria (F1,2054=14.38, P=0.0002; F1,2419=16.52, P<0.0001). CONCLUSIONS: Contingency management optimized outcomes using nicotine replacement therapy for reducing cigarette smoking during treatment for opiate dependence, although long-term effects are not generally maintained. Findings document strong associations between reductions in cigarette smoking and reductions in illicit substance use during treatment.
Adolescent↗
The gap between research and practice in substance abuse treatment.
Integrating science-based practices into clinical care has become an increasingly important theme in the substance abuse field. The authors describe various factors that have traditionally kept researchers and practitioners from collaborating with one another and outline steps being taken to encourage a partnership between these two groups. Strategies for continuing to close the gap between research and practice are provided, including the incorporation of policy makers and consumers and their families into the process. The implementation of science-based treatment strategies into mainstream substance abuse care will depend partly on the new relationships that are built on the communication and cooperation between researchers and practitioners.
Humans↗
If a US drug abuse epidemic fails to include a major east coast city, can it be called an epidemic?
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Central Nervous System Stimulants↗
Will the methamphetamine problem go away?
Methamphetamine use has clearly reached epidemic proportions in large parts of the western and midwestern US. Because of the regional specificity of methamphetamine use, there is speculation that it may be a temporary problem and not a long-term public health problem. Unfortunately there are a number of factors that suggest that significant methamphetamine problems may persist or even expand. For this reason, it is important that federal law enforcement, prevention, research and treatment agencies prepare strategies to address the likelihood of this persisting problem. This article reviews the issues concerning the future of the methamphetamine problem in the US and provides some recommendations for setting priorities to address the problem.
Adult↗
A comparison of patterns of methamphetamine and cocaine use.
Typical use patterns of methamphetamine (MA) users were examined using self-report measures from 120 MA and 63 cocaine users. Twenty (14 MA and 6 cocaine) of the participants also took part in structured interviews designed to provide more specific descriptions of their drug use. The typical MA user uses more than 20 days a month. Use is evenly spaced throughout the day, and although the amount of drug used per day is not different, MA users use fewer times per day than do cocaine users. Fewer of the cocaine users are continuous users, and they use in the evening rather than the daytime. The cocaine pattern of fewer days of use, evening use, and more frequent doses per day fits a picture of recreational use, whereas the all-day-most-days methamphetamine pattern does not.
Adult↗
Cognitive performance of current methamphetamine and cocaine abusers.
Forty currently using methamphetamine (MA) abusers, 40 currently using cocaine (COC) abusers, and 80 comparison participants who did not use psychostimulants received a cognitive battery and questionnaires covering medical history and stimulant use patterns. Forty comparison participants were matched to the 40 MA users on age, education, ethnicity, and gender. The other 40 comparison participants were matched to the cocaine users on the same variables. This design was chosen because there were significant differences in age and ethnicity between COC and MA users that precluded a direct comparison between the groups. The COC group was older and predominantly African American compared to the predominantly Caucasian MA group. When compared to their matched non-using control groups, both MA and COC abusers were impaired on cognitive measures, but the type and degree of impairments were somewhat different.
Adult↗
Cognitive deficits among methamphetamine users with attention deficit hyperactivity disorder symptomatology.
Understanding the association between attention deficit hyperactivity disorder (ADHD) and substance abuse, specifically methamphetamine (MA) abuse, is challenging, partly because little is known about the specific constellation of cognitive impairments produced by MA. The present investigation serves to address this relationship by comparing the cognitive performance of MA abusers with ADHD symptomatology (n = 28) and MA abusers without ADHD symptomatology (n = 41) on tests of attention, memory and general intellectual functioning, executive functioning, problem solving, verbal fluency, and abstract thinking. Both MA samples had deficiencies in measures of memory and learning function, psychomotor speed and abstract thinking when compared to a control group (n = 40). Additional deficits were noted on tasks involving executive functioning, attention, and general intellectual functioning in MA abusers with ADHD symptomatology. The preliminary data suggests that executive function deficits and some of the symptoms associated with long-term MA use may be due to the fact that a large proportion of MA addicts had ADHD symptomatology as children.
Adult↗
Status of methamphetamine users 2-5 years after outpatient treatment.
Increasing numbers of methamphetamine users sought treatment during the decade of the 1990s. Little is known about the post treatment status of methamphetamine users who enter treatment. The data presented in this paper describe the outcome status of a group of a convenience sample of 114 methamphetamine users from a total group of 500 methamphetamine users who were treated 2-5 years prior to a follow up interview. Since the sample was not randomly selected, no specific treatment outcome attribution is possible. Methamphetamine use and other drug use of the follow up sample was substantially reduced from pretreatment levels. In general, the follow up status of the sample was much improved as compared to before treatment. However, headaches and depression were reported at a similar rate at follow up as had been reported at treatment admission.
Adult↗
Dancing with strangers: will U.S. substance abuse practice and research organizations build mutually productive relationships?
The scientific knowledge gained from research has not been extensively integrated into the U.S. substance abuse treatment system. A clear call to arms has been issued by the U.S. federal treatment and research agencies to bring research and practice together to create a better treatment system and a more responsive research agenda. The current federally sponsored initiatives to "close the gap" between research and practice are large and well funded. The field appears ready to change and realize the mutual benefits that can be achieved from the increased "bleeding" of research and practice. However, while the music has started and the partners seem willing, there are still many obstacles to a successful dance.
Ambulatory Care↗
The substance abuse treatment system in the U.S. What is it? What does it do? Myths and misconceptions.
The current system of care for treating individuals with substance use disorders evolved during the second half of the 20th century. It has roots in self-help movements and in medical and scientific research findings, and has been shaped by emerging drug trends, public health problems, and uneven treatment financing policies. Currently, the bulk of care is provided by: structured outpatient treatment programs; narcotic treatment programs; variable length residential programs (with and without medical services); and modified therapeutic communities. The majority of the services provided within these organizations meet professional credentialing and/or licensing requirements. The treatment delivery system has made great strides in the past decade to improve quality of care, incorporate outcomes monitoring, and increase the role of empirically supported treatments. Research on the effectiveness of substance abuse treatment indicates that the success rates for these services are comparable to other areas of medical/psychiatric care.
Ambulatory Care↗