Drug Counseling Research Articles

Supportive-Expressive Psychodynamic Therapy for Cocaine Dependence: A Closer Look.

Using data from the National Institute on Drug Abuse Collaborative Cocaine Treatment Study, this article focuses on the outcomes of patients who received supportive-expressive (SE) psychodynamically-oriented psychotherapy (plus group drug counseling; GDC). Short-term SE for cocaine dependent individuals, while not the most efficacious treatment examined in the study (individual drug counseling [IDC] plus GDC was), produced large improvements in cocaine use. In addition, there was evidence that SE was superior to IDC on change in family/social problems at the 12 month follow-up assessment, particularly for those patients with relatively more severe difficulties in this domain at baseline. For patients who achieved abstinence early in treatment, SE produced comparable drug use outcomes to IDC, with mean drug use scores numerically lower for SE at all of the follow-up assessments (9, 12, 15, and 18 months). SE patients who achieved initial abstinence decreased cocaine use from a mean 10.1 days per month at baseline to a mean of 1.3 days at 12 months.

Maintenance treatment with buprenorphine and naltrexone for heroin dependence in Malaysia: a randomised, double-blind, placebo-controlled trial

Expansion of access to effective treatments for heroin dependence is a worldwide health priority that will also reduce HIV transmission. We compared the efficacy of naltrexone, buprenorphine, and no additional treatment, in patients receiving detoxification and subsequent drug counselling, for maintenance of heroin abstinence, prevention of relapse, and reduction of HIV risk behaviours. 126 detoxified heroin-dependent patients, from an outpatient research clinic and detoxification programme in Malaysia, were randomly assigned by a computer-generated randomisation sequence to 24 weeks of manual-guided drug counselling and maintenance with naltrexone (n=43), buprenorphine (n=44), or placebo (n=39). Medications were administered on a double-blind and double-dummy basis. Primary outcomes, assessed by urine testing three times per week, were days to first heroin use, days to heroin relapse (three consecutive opioid-positive urine tests), maximum consecutive days of heroin abstinence, and reductions in HIV risk behaviours over 6 months. The study was terminated after 22 months of enrolment because buprenorphine was shown to have greater efficacy in an interim safety analysis. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00383045. We observed consistent, linear contrasts in days to first heroin use (p=0.0009), days to heroin relapse (p=0.009), and maximum consecutive days abstinent (p=0.0007), with all results best for buprenorphine and worst for placebo. Buprenorphine was associated with greater time to first heroin use than were naltrexone (hazard ratio 1.87 [95% CI 1.21-2.88]) or placebo (2.02 [1.29-3.16]). With buprenorphine, we also recorded significantly greater time to heroin relapse (2.17 [1.38-3.42]), and maximum consecutive days abstinent than with placebo (mean days 59 [95% CI 43-76] vs 24 [13-35]; p=0.003); however, for these outcomes, differences between buprenorphine and naltrexone were not significant. Differences between naltrexone and placebo were not significant for any outcomes. HIV risk behaviours were significantly reduced from baseline across all three treatments (p=0.003), but the reductions did not differ significantly between the three groups. Our findings lend support to the widespread dissemination of maintenance treatment with buprenorphine as an effective public-health approach to reduce problems associated with heroin dependence.

Opportunistic screening and clinician‐delivered brief intervention for high‐risk alcohol use among emergency department attendees: A randomized controlled trial

To evaluate the feasibility and efficacy of routine opportunistic screening and brief intervention (BI) by ED staff to reduce high-risk alcohol consumption. This was an open, randomized controlled trial with allocation blinding performed over 12 months. Using the Paddington Alcohol Test, adult patients were screened for high-risk alcohol use. Consenting patients who were screened positive were eligible for randomization to no counselling (standard care, SC), same-day BI by an emergency nurse or doctor or motivational intervention (MI) within 1 week by off-site drug and alcohol counsellors. Telephone follow up was performed at 1 and 3 months. The primary outcome was maximum self-reported daily standard drinks consumed. Analysis was by intention to treat. Of 32,965 eligible patients, 10,274 were screened, 1043 were positive, 468 consented to the study, and 161, 159 and 148 were allocated to SC, BI and MI, respectively. In the MI group, 133 declined intervention or failed to attend. At 3 months, 96, 81 and 74 participants in the SC, BI and MI groups, respectively, were contactable and consented to telephone interview. Overall, maximum daily alcohol consumption decreased from a median of 13.5 standard drinks at enrolment to 9.25 drinks at 3 months. At 3 months, SC participants reported fewer drinks than those randomized to MI. In the present study, neither BI nor MI was better than SC in reducing high-risk alcohol consumption. Uptake of opportunistic screening by ED staff was poor, as was patient compliance with off-site counselling.

Depressed patients’ preferences for education about medications by pharmacists in Kuwait

Objective To assess patients’ opinion toward receiving written or specialized verbal pharmacists’ interventions and to determine the effect of these interventions on patients’ medication knowledge. Methods 150 newly diagnosed patients with unipolar depression and initiated with a single antidepressant were randomized into 3 groups: control, leaflet and counselling, and interviewed at initiation and after 6–8 weeks of treatment at the outpatient department of the Psychiatric Hospital in Kuwait. Results 50% of respondents asserted that clinicians did not give them sufficient information while 90% favoured the idea of receiving further information about therapy. Forty seven percent of participants failed to return for the second follow-up appointment. The drop-out rate was 66% in the control, 42% in the Leaflet and only 34% in the counselling groups ( P = 0.004). A broad support for receiving leaflets and drug counselling (97%) was found among attendees. Moreover, 94% of the counselling and 79% of the leaflets group affirmed that they received adequate information compared to 47% of the control ( P = 0.001). Counselling was found to be significantly associated with a much higher recall of medicine name (OR = 9.6, P = 0.01), how to manage missed doses (OR = 8.9, P = 0.007), and correct use of medication (OR = 31.3, P < 0.001). Leaflet use was less strongly associated than counselling and was statistically significant for recall regarding correct use of medication (OR = 8.4, P = 0.009). Conclusion Pharmacists in a psychiatric institution can play an important role in satisfying patient demands for specialized information about their medications. Patients with depression appear very eager to receive additional drug information with modest difference between the written and the verbal counselling interventions. Patients looked at the two interventions in a very positive manner and no difference was observed between patients in the leaflets and in the counselling group with regards to how helpful, sufficient, supportive and reassuring was the educational material. However, both interventions were more informative than the control in conveying elemental drug information to patients. Practice Implications In contrast with the lack of enthusiasm that some clinicians express, the affirmativeness that was expressed by patients towards receiving written or verbal specialized educational interventions by pharmacists may support the psychiatric hospital pharmacists’ stands in providing them for all patients which may aid in improving patients compliance and probably treatment outcome.

Data Show Why Drug Counseling Critical for Schizophrenia Patients

Data Show Why Drug Counseling Critical for Schizophrenia Patients

A randomized control trial examining the effect of acceptance and commitment training on clinician willingness to use evidence-based pharmacotherapy.

This study evaluated the effectiveness of acceptance and commitment training (ACT) for increasing drug and alcohol counselors' willingness to use evidence-based agonist and antagonist pharmacotherapy. Fifty-nine drug and alcohol counselors were randomly assigned to either a 1-day ACT workshop or a 1-day educational control workshop. Both groups then attended a 2-day workshop on empirically supported treatments for substance abuse. Measures were taken at pre- and posttraining and 3-month follow-up on reported use of pharmacotherapy, willingness to use pharmacotherapy, perceived barriers to implementing new treatments, and general acceptance. As compared with those in the education alone condition, participants in the ACT condition showed significantly higher rates of referrals to pharmacotherapy at follow-up, rated barriers to learning new treatments as less believable at posttraining and follow-up, and showed greater psychological flexibility at posttraining and follow-up. Mediational analyses indicated that reduced believability of barriers and greater psychological flexibility mediated the impact of the intervention. Results support the idea that acceptance-based interventions may be helpful in addressing the psychological factors related to poor adoption of evidence-based treatments.

High Psychiatric Symptom Severity Is a Moderator of Substance Abuse Treatment Outcomes Among Women in Single vs. Mixed Gender Group Treatment

Objective: This exploratory study examined psychiatric symptom severity as a moderator of outcomes among women receiving either the Women's Recovery Group (WRG), a new manualized group treatment for substance use disorders combining single-gender group composition and women-focused content, or Group Drug Counseling (GDC), an empirically supported mixed-gender group treatment. Methods: We used a mixed model analysis of variance. Results: We found a significant 3-way interaction effect of treatment condition, time, and baseline Brief Symptom Inventory scores as well as Beck Depression Inventory scores. Conclusion: Single-gender group treatment may confer added benefit for women with substance abuse and high psychiatric symptom severity than mixed-gender treatment.

福岡大学病院における薬剤師レジデント制度の構築

In April 2006,Fukuoka University Hospital started a resident pharmacist system for the postgraduate training of pharmacists.After the completion of the general practice (GP) course which takes 1 year,students choose specialty courses from a list that includes those on cancer chemotherapy and diabetic medicine.The GP course includes practical training (about 1,800 hours),lectures (40 hours),Problem Based Learning (six hours,excluding time for collecting data),role-playing in informed consent training (two hours),and field training at another hospital (one week) and a pharmacy (two days).Six months after the start of the GP course,we conducted a survey of resident pharmacists and staff pharmacists to assess the validity of the program.In the results,training in dispensing was cited as the most useful by the resident pharmacists.Next came TPN (total parenteral nutrition),mixing of injectable anti-cancer drugs and drug counseling for in-patients.However,few of them said that the learning goals set for the program had been achieved,which indicates the necessity of establishing an advanced GP course in the second year so that students can learn more about a wide range of basic pharmacist tasks.Ninety-seven percent of the staff pharmacists responded that the program was beneficial for the pharmacy department,indicating that it could enhance human resources and staff motivation.Our findings show that the resident pharmacist system is instructive and useful for not only in postgraduate education but also for the pharmacy department.

Behavioral drug and HIV risk reduction counseling (BDRC) with abstinence-contingent take-home buprenorphine: A pilot randomized clinical trial

This pilot randomized clinical trial evaluated whether the efficacy of office-based buprenorphine maintenance treatment (BMT), provided with limited counseling or oversight of medication adherence is improved by the addition of individual drug counseling and abstinence-contingent take-home doses of buprenorphine. After a 2-week buprenorphine and stabilization period, heroin dependent individuals ( n = 24) in Muar, Malaysia were randomly assigned to Standard Services BMT (physician administered advice and support, and weekly, non-contingent medication pick-up) or Enhanced Services (nurse-delivered manual-guided behavioral drug and HIV risk reduction counseling (BDRC) and abstinence-contingent take-home buprenorphine (ACB), 7 day supply maximum). Outcomes included retention, proportion of opioid-negative urine tests, self-reported drug use, and self-reported HIV risk behaviors. 12/12 (100%) of Enhanced Services and 11/12 (92%) of Standard Services participants completed the entire protocol. The proportion of opioid-negative urine tests increased significantly over time for both groups ( p < 0.001), and the reductions were significantly greater in the Enhanced Services group ( p < 0.05); Enhanced Services group achieved higher overall proportions of opiate negative urine toxicology tests (87% vs. 69%, p = 0.04) and longer periods of consecutive abstinence from opiates (10.3 weeks vs. 7.8 weeks, p = 0.154). Both groups significantly reduced HIV risk behaviors during treatment ( p < 0.05), but the difference between Enhanced and Standard Services (26% vs. 17% reductions from the baseline levels, respectively) was not statistically significant ( p = 0.9). Manual-guided behavioral drug and HIV risk reduction counseling and abstinence-contingent take-home buprenorphine appear promising for adding to the efficacy of office-based BMT provided with limited drug counseling and medication oversight.

Substance Abuse Counselor Certification in California: How is Nicotine Addiction Addressed?

Persons entering substance abuse treatment smoke at rates three to four times that of the general population, but programs providing substance abuse treatment rarely address comorbid nicotine addiction. With California's recent adoption of a regulation requiring alcohol and other drug (AOD) counselors to be certified, this study explored the degree to which nicotine addiction education was required or recommended to obtain certification by examining pertinent documentation and Web sites. Findings reveal two main points. First, the text of the California AOD Counselor Certification regulation and supporting documents make no mention of cigarettes, nicotine, smoking, or tobacco, and thus do not mandate or recommend they be addressed in the counselor certification process. Second, although nicotine or tobacco were not mentioned in regulatory or supporting documents, four of the 10 certifying organizations mentioned nicotine at least once in handbooks, program books, continuing education topics, or other materials available online. One certifying organization offered specialization in smoking and nicotine addiction as separate tracks within its certification training program. While systematic inclusion of smoking and nicotine addiction in counselor training offers one strategy to address smoking in substance abuse treatment settings, these topics are not addressed in regulations or supporting documents governing the certification of California AOD counselors.

Augmenting continuing education with psychologically focused group consultation: Effects on adoption of group drug counseling.

This study examines whether adding psychologically focused group consultation to a standard 1-day continuing-education workshop on Group Drug Counseling (GDC), a group therapy with evidence of effectiveness in the treatment of substance abuse problems, improves GDC adoption. Counselors who had taken a 1-day workshop were randomly assigned to an 8-week course of group consultation that met for 1.5 hr per session (n = 16) or to no additional contact (n = 14). The group consultation used Relapse Prevention and Acceptance and Commitment Therapy principles to help participants overcome psychological barriers to the adoption of GDC. Results showed that the 1-day workshop resulted in attempts by trainees to implement the new therapy, but that the consultation condition maintained significantly higher levels of adoption and 2- and 4-month followups. Additionally, those in the group consultation condition reported a higher sense of personal accomplishment at the 4-month followup. These findings suggest that empirically supported psychotherapy models can be used to decrease clinicians' psychological barriers to adoption of evidence-based psychotherapy methods. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Practice of Pharmaceutical Care — Therapeutic Drug Monitoring and Pharmacoeconomics of Glaucoma

AbstractChemInform is a weekly Abstracting Service, delivering concise information at a glance that was extracted from about 200 leading journals. To access a ChemInform Abstract, please click on HTML or PDF.

Attributional Bias of Offenders in Rehabilitation Therapy Workers

AbstractAttribution theory was used to provide a conceptual analysis of how personal responsibility and blame are ascribed to fictional male and female offenders. Thirty drug and alcohol counsellors participated in the study; half read a description of a crime committed by a female and the other half read the same description of the crime but committed by a male. Counsellors rated the offence in terms of the attributional domains of internality, control, and stability and then listed potential treatment targets. Offender sex influenced differentially attribution of blame with counsellors tending to attribute less blame to an offender of the same gender. This effect was particularly pronounced in the case of female counsellors.

Pharmaceutical Care in Community Pharmacies: Practice and Research in Brazil

To discuss the provision of pharmaceutical services and pharmaceutical care in Brazil. Professional training and pharmaceutical services are undergoing a period of restructuring in Brazil, including the adoption of incentives for pharmaceutical care. Some important national measures include the rational use of medications, evidence-based medicine, and pharmacovigilance. A new and more generalist pharmacy curriculum is being implemented and tailored for the Brazilian Public Health System; recently, the Brazilian government has provided resources for pharmaceutical care research. A proposal for national consensus in Brazilian pharmaceutical care was published in 2002. The components of this proposal include drug dispensing, counseling, health education, symptoms advice, and pharmacotherapy follow-up. Pharmacy practice is currently focused on drug dispensing and logistic aspects of drug distribution. Professionals are satisfied with patients' confidence in being counseled by pharmacists and reveal interest in extending their role in patient care. Most pharmacy customers were originally unaware of the term "pharmaceutical care"; however, following an explanation, they showed an interest in this service. Furthermore, over 50% stated that they would pay for this service. Despite these initiatives, numerous barriers to the development of pharmaceutical care remain, the main ones being the commercial objective of most pharmacies that sell medications and the insufficient training of professionals. Although government-owned pharmacies also distribute medications, they do not meet all of the needs of the population and lack sufficient pharmacists. Several actions are required to stimulate the implementation and development of pharmaceutical care and services in Brazil. Recent research incentives in pharmaceutical care and reorientation of pharmacy education will contribute to this development.

The cost‐effectiveness of four treatments for marijuana dependence

To analyze data from a randomized clinical trial to determine the cost-effectiveness of using contingency management (CM) and motivational/skills building therapy (motivational enhancement therapy/cognitive-behavioral therapy: MET/CBT) to treat young adults with marijuana dependence. PARTICIPANTS, DESIGN AND MEASUREMENTS: A total of 136 marijuana-dependent young adults, all referred by the criminal justice system, were randomized to one of four treatment conditions: MET/CBT with CM, MET/CBT without CM, drug counseling (DC) with CM and DC without CM. Patient outcome measures include the longest duration of confirmed marijuana abstinence (LDA) during treatment and the total number of marijuana-free urine specimens provided during treatment. Costs were collected retrospectively from the provider and include the costs of therapy, patient drug testing, and those associated with the incentives component (value of vouchers, time to administer the voucher system). Out-patient substance abuse clinic in New Haven, Connecticut, USA. Which treatment is the most cost-effective depends on the threshold values of an additional week of LDA or an additional marijuana-free urine specimen. For example, the most effective treatment, MET/CBT with CM, was also the most cost-effective treatment at the highest threshold values, while the least effective treatment, DC, was the most cost-effective at the lowest values. Because consensus threshold values for these patient outcomes do not exist, results are presented showing the ranges of values over which each treatment would be considered cost-effective compared to the others. Acceptability curves are presented to show the decision uncertainty associated with these ranges. The results are shown to be robust to (i) sensitivity analyses on several key cost parameters and (ii) patient outcomes measured during the 6-month follow-up period. This study uses incremental cost-effectiveness ratios and acceptability curves to shed light on the relative cost-effectiveness of four interventions for treating young adults with marijuana dependence. Given the relatively small and specialized nature of our study sample, and the fact that we examined a CM procedure with a single reinforcement schedule, additional studies are warranted to determine the reliability and generalizability of our results both to alternative marijuana-using populations and to CM procedures with alternative incentive parameters. Nevertheless, the relative durability of effects of MET/CBT compared to DC through the 6-month follow-up, and its cost-effectiveness over a comparatively wide range of threshold values, underscores the promise of this approach.

Aboriginal and non‐Aboriginal health differentials in Australian prisoners

Compare the self-reported physical and mental health of Aboriginal and non-Aboriginal prisoners in New South Wales (NSW). Cross-sectional random sample. Twenty-nine correctional centres (27 male and two female) in NSW. 747 men (227 Aboriginal) and 167 women (29 Aboriginal) in full-time custody. Face to-face interviews were used to record self-reported health status. Aboriginal prisoners differed significantly from non-Aboriginal inmates in several socio-demographic and criminographic factors. However, few differences were observed in health status between Aboriginal and non-Aboriginal men and women. After adjusting for age, Aboriginal men were more likely to report high blood pressure and diabetes. No differences were found in chronic health conditions in the female group. Aboriginal men had higher SF-36 scores than non-Aboriginal men on general health, vitality, and mental health. Aboriginal women had lower scores than non-Aboriginal women on social functioning and role-emotional but scored higher on the role-physical dimension. Aboriginal inmates were more likely to report seeing certain health professionals (doctors, dentists, drug and alcohol counsellors, and optometrists) in prison compared with the community. The health of Aboriginal and non-Aboriginal prisoners is remarkably similar in this population group. Few differences were observed in self-reported chronic health conditions. Aboriginal prisoners report using prison health services more while in prison compared with the community. This highlights that for many, prison is a rare opportunity to contact health services.

Implicit learning, executive function and hedonic activity in chronic polydrug abusers, currently abstinent polydrug abusers and controls

The study seeks to evaluate impairments of implicit learning and executive function in chronic polydrug abusers. It was hypothesized that implicit learning and executive function correlate with anhedonia. A cross-sectional group comparison. Department of Psychiatry, University of Tübingen, Germany. Participants A total of 25 male polydrug abusers with opiate dependence, n = 26 polydrug abusers abstinent for more than 3 months and n = 26 non-drug-using healthy males. Abstinent polydrug abusers were recruited from a community treatment centre, current polydrug abusers from local drug counselling services and controls through advertisements. A psychological battery assessing implicit learning (serial reaction-time task), various executive functions (latent inhibition, delayed matching-to-sample, Trail Making Test, acquisition and modification of conditioned responses, figural reasoning) and verbal logic memory was administered. Hedonic thoughts and activities as well as depressive symptoms were assessed through questionnaires. In chronic polydrug abusers, there were moderate impairments of implicit learning, of acquisition, reversal and extinction of conditioned responses, of latent inhibition as well as anhedonia, while working memory was spared. In the abstinent group, cognitive performance was normal except for latent inhibition and more anhedonia and depression than in controls. The findings suggest that current polydrug abusers suffer from impairment of many cognitive functions and from anhedonia. During abstinence, there is near normal cognitive function but still anhedonia. Anhedonia was correlated with implicit learning but not with executive function.

Creation as transformation: Parenting as a turning point in drug users’ lives

AbstractThis paper is drawn from a narrative inquiry into how ex‐drug users understand the connection between childhood trauma and their subsequent drug misuse. The research was commissioned by a community drugs project. Eight participants were selected from respondents to an advertisement in a counselling journal, five of whom are qualified psychological therapists. The particular focus of this paper is on the interconnection of childhood trauma/abuse, drug misuse and parenting, by showing participants’ own experience of being parented and how the experience of becoming a parent helped them to transform their relationship with drugs. The paper draws attention to the therapeutic value of recognising the complex contextual factors that influence the parenting abilities of problematic drug users, and of building upon the positive attitudes, hopes, values and capabilities that underscore the ‘good parenting’ found in their stories. The work suggests that drug rehabilitation, treatment or counselling might usefully focus on parent–child relationships, which can become a turning point for identity transformation.

The Women's Recovery Group Study: A Stage I trial of women-focused group therapy for substance use disorders versus mixed-gender group drug counseling

The aim of this Stage I Behavioral Development Trial was to develop a manual-based 12-session Women's Recovery Group (WRG) and to pilot test this new treatment in a randomized controlled trial against a mixed-gender Group Drug Counseling (GDC), an effective manual-based treatment for substance use disorders. After initial manual development, two pre-pilot groups of WRG were conducted to determine feasibility and initial acceptability of the treatment among subjects and therapists. In the pilot stage, women were randomized to either WRG or GDC. No significant differences in substance use outcomes were found between WRG and GDC during the 12-week group treatment. However, during the 6-month post-treatment follow-up, WRG members demonstrated a pattern of continued reductions in substance use while GDC women did not. In addition, pilot WRG women with alcohol dependence had significantly greater reductions in average drinks/drinking day than GDC women 6 months post-treatment ( p < .03, effect size = 0.81). While satisfaction with both groups was high, women were significantly more satisfied with WRG than GDC ( p < .009, effect size = 1.11). In this study, the newly developed 12-session women-focused WRG was feasible with high satisfaction among participants. It was equally effective as mixed-gender GDC in reducing substance use during the 12-week in-treatment phase, but demonstrated significantly greater improvement in reductions in drug and alcohol use over the post-treatment follow-up phase compared with GDC. A women-focused single-gender group treatment may enhance longer-term clinical outcomes among women with substance use disorders.

Counselor perceptions of organizational factors and innovations training experiences

Because work environment is central to understanding job performance, drug counselor perceptions of their programs and their skills were examined in relation to their attitudes about innovations training and its utilization. Latent profile analysis of measures on organizational climate and staff attributes for 1047 counselors from 345 programs defined three categories of counselors—labeled as isolated, integrated, and exceptional. All had generally positive views of their professional skills, although the isolated group scored lower on scales representing professional growth and influence on peers. They were less positive about the “climate” of programs in which they worked and were higher on stress. Program resources predicted the counselor groups, with the isolated having more limited resources. Counselor categorizations also differed in terms of workshop training experiences, with the isolated group of counselors reporting significantly less exposure, satisfaction, and program-wide use of workshop training.