Drug Counseling Research Articles

Counseling Requirements for Buprenorphine Maintenance in Primary Care

Objective: This preliminary study was conducted to establish the minimal counseling requirements for buprenorphine maintenance in primary care settings. A brief, nurse-administered, medically focused counseling approach for buprenorphinemaintained patients, Medical Management (MM), was designed by the authors. To evaluate preliminary feasibility and efficacy of MM prior to using it in a primary care setting, we evaluated it in a methadone maintenance program. Method: Fourteen opioid dependent patients were treated for 12 weeks with thrice-weekly buprenorphine plus either MM provided thrice weekly (5–10 minutes) by an RN, or MM plus individual Drug Counseling (MM+DC). DC was provided weekly (45 minutes) by a Ph.D.-level psychologist or a Certified Alcohol and Drug Counselor. Results: Seven of the 7 MM and 6 of the 7 MM+DC patients completed all 12 weeks of the study. Rates of opioid-positive urine toxicology tests averaged 72% for MM and 54% for MM+DC. Two of the 7 MM and 4 of the 7 MM+DC patients achieved ≥3 consecutive weeks of opioid-negative urine toxicology tests. None of these differences reached statistical significance. Conclusions: These preliminary findings demonstrate the feasibility and efficacy of MM and suggest, as with methadone, that DC may be a necessary component of buprenorphine treatment of opioid dependence. Therefore, providers of office- or primary care-based buprenorphine maintenance may need to incorporate aspects of drug counseling.

Proposed recommendations for the management of HIV post-exposure prophylaxis after sexual, injecting drug or other exposures in Europe.

Post-exposure prophylaxis (PEP) is the standard of care for a healthcare worker (HCW) accidentally exposed to an HIV infected source person (occupational exposure), but this is not the case for non-occupational exposures. Very few national guidelines exist for the management of non-occupational exposures to HIV in Europe, contrarily to the occupational ones. The administration of non-occupational post-exposure prophylaxis (NONOPEP) for HIV may be justified by: a biological plausibility, the effectiveness of PEP in animal studies and occupational exposures in humans, efficacy in the prevention of mother to child HIV transmission, and cost effectiveness studies. These evidences, the similar risk of HIV transmission for certain non-occupational exposures to occupational ones, and the conflicting information about attitudes and practices among physicians on NONOPEP led to the proposal of these European recommendations. Participant members of the European project on HIV NONOPEP, funded by the European Commission, and acknowledged as experts in bloodborne pathogen transmission and prevention, met from December 2000 to December 2002 at three formal meetings and a two day workshop for a literature review on risk exposure assessment and the development of the European recommendations for the management of HIV NONOPEP. NONOPEP is recommended in unprotected receptive anal sex and needle or syringe exchange when the source person is known as HIV positive or from a population group with high HIV prevalence. Any combination of drugs available for HIV infected patients can be used as PEP and the simplest and least toxic regimens are to be preferred. PEP should be given within 72 hours from the time of exposure, starting as early as possible and lasting four weeks. All patients should receive medical evaluation including HIV antibody tests, drug toxicity monitoring and counseling periodically for at least 6 months after the exposure. NONOPEP seems to be a both feasible and frequent clinical practice in Europe. Recommendations for its management have been achieved by consensus, but some remain controversial, and they should be updated periodically. NONOPEP should never be considered as a primary prevention strategy and the final decision for prescription must be made on the basis of the patient-physician relationship. Finally, a surveillance system for these cases will be useful to monitor NONOPEP practices in Europe.

Naltrexone for heroin dependence treatment in St. Petersburg, Russia

Naltrexone may be more effective for treating opioid (heroin) dependence in Russia than in the U.S. because patients are mostly young and living with their parents, who can control medication compliance. In this pilot study we randomized 52 consenting patients who completed detoxification in St. Petersburg to a double blind, 6-month course of biweekly drug counseling and naltrexone, or counseling and placebo naltrexone. Significant differences in retention and relapse favoring naltrexone were seen beginning at 1 month and continuing throughout the study. At the end of 6 months, 12 of the 27 naltrexone patients (44.4%) remained in treatment and had not relapsed as compared to 4 of 25 placebo patients (16%; p<0.05). Since heroin dependence is the main way HIV is being spread in Russia, naltrexone is likely to improve treatment outcome and help reduce the spread of HIV if it can be made more widely available.

Heroin diffusion in the mid‐Hudson region of New York State

Prompted by the history of heroin diffusion in the United States, press reports and building on previous research into retail heroin distribution, ethnographic research was undertaken identifying and describing retail distribution and diffusion of heroin in and into medium- and small-sized towns in the mid-Hudson region of New York State. In conjunction with fieldwork, in-depth tape-recorded interviews were conducted with recent admissions (30 days) at 28 different drug treatment facilities located in the region. Interviews were also conducted with drug counselors, narcotic officers, drug treatment administrators and the county commissioners of mental hygiene. Heroin-dependent individuals who have access to cheaper heroin in urban areas, such as New York City, Newark, and Patterson, New Jersey, drive retail heroin distribution in the mid-Hudson region. They travel to these cities, purchase heroin in quantity (costing $8-10 per bag), return to the region and sell premium-priced heroin ($20-$25 per bag) mostly to irregular users who do not have access to retail drug sellers in urban areas. Price disparity contributes to a recurrent process whereby irregular users who are able to gain access to cheaper heroin in urban areas, return to the mid-Hudson and sell premium-priced heroin to other users who do not have access to cheaper heroin. This process contributes to the diffusion of heroin abuse.

Drug counselling in pregnancy: an opinion survey of French community pharmacists

The aim of the present study was to determine whether community pharmacists recommend appropriate medications and give valid information to pregnant women. A total of 163 community pharmacists randomly selected in the Midi-Pyrénées area were interviewed by means of an open questionnaire. Ten scenarios were proposed concerning back pain, headache, coughs and sore-throats, fever, constipation, nausea, dyspepsia, 'venous insufficiency', allergic rhinitis and insomnia. Out of the total, 130 pharmacists accepted to answer. Out of them 94.5% reported advising homeopathy, especially for coughs and allergy. They often advised medication for pain, fever, nose and oropharynx disorders, 'venous insufficiency', dyspepsia or constipation. By contrast, they referred the women to the general practitioner for nausea and vomiting or back pain. Advice without drug dispensation was given for gastrointestinal disorders or 'venous insufficiency'. Phytotherapy only concerned 0.5-2% of the answers except for anxiety and sleep disturbances (59%), 'venous disorders'(17%) and sore-throat (9%). Pharmacists' answers were sometimes inappropriate involving (1) pharmacologically illogical advice, (2) drugs for which neither clinical nor experimental data are available and (3) drugs potentially harmful in pregnancy. The present study shows that French community pharmacists do not always give appropriate advice to pregnant women. As primary health care providers, pharmacists have to improve counselling regarding drug use in pregnancy.

Therapist Satisfaction With Four Manual-Based Treatments on a National Multisite Trial: An Exploratory Study.

Lisa M. Najavits and Roger D. Weiss, Department of Psy-chiatry, Harvard Medical School, and McLean Hospital, Bel-mont, Massachusetts; Frank Ghinassi and Michael E. Thase,Department of Psychiatry, Western Psychiatric Institute andClinic, University of Pittsburgh; Amanda Van Horn, LynneSiqueland, and Lester Luborsky, Department of Psychiatry,University of Pennsylvania Medical School; Arlene Frank,Department of Psychiatry, Brookside Hospital, Nashua, NewHampshire.Arlene Frank is now at Health Enhancement Services, Inc.,Research Division, Boca Raton, Florida, and Department ofEpidemiology & Public Health, University of Miami Schoolof Medicine.The National Institute on Drug Abuse (NIDA) Collabora-tive Cocaine Treatment Study was a NIDA-funded coopera-tive agreement involving four clinical sites, a coordinatingcenter, and NIDA staff. The coordinating center at the Uni-versity of Pennsylvania included Paul Crits-Christoph, PhD(principal investigator), Lynne Siqueland, PhD (project coor-dinator), Karla Moras, PhD (assessment unit director), JesseChittams, MA (director of data management/analysis), andLarry R. Muenz, PhD (statistician). The collaborating scien-tists at the Treatment Research Branch, Division of Clinicaland Research Services at NIDA, were Jack Blaine, MD, andLisa Simon Onken, PhD. The four participating clinical siteswere University of Pennsylvania: Lester Luborsky, PhD(principal investigator), Jacques P. Barber, PhD (co–principalinvestigator), Delinda Mercer, MA (project director); Brook-side Hospital: Arlene Frank, PhD (principal investigator), Ste-phen F. Butler (co–principal investigator), Sarah Bishop, MA(project director); Harvard Medical School, McLean Hospital,and Massachusetts General Hospital: Roger D. Weiss, MD(principal investigator), David R. Gastfriend, MD (co–principal investigator), Lisa M. Najavits, PhD (project direc-tor), and Margaret Griffin (research associate); and University ofPittsburgh, Western Psychiatric Institute and Clinic: MichaelThase, MD (principal investigator), Dennis Daley, MSW (co–principal investigator), Ishan M. Salloum, MD (co–principalinvestigator), and Judy Lis, MSN (project director). The train-ing unit heads of the Cognitive Therapy Training Unit wereAaron T. Beck, MD (University of Pennsylvania), and BruceS. Liese, PhD (University of Kansas Medical Center); headsof the Supportive–Expressive Therapy Training Unit wereLester Luborsky and David Mark, PhD (University of Penn-sylvania); heads of the Individual Drug Counseling Unit wereGeorge Woody, MD (Veterans Administration, University ofPennsylvania Medical School), and Delinda Mercer, MA(University of Pennsylvania); and heads of the Group Drug

Research Findings on Psychotherapy of Addictive Disorders

Psychoanalytically trained physicians working in methadone programs in the 1980s theorized that adding psychotherapy to addiction treatment would improve outcomes. Since then, a number of clinical studies have evaluated the effect of psychotherapy, drug counseling, and twelve-step intervention on treatment outcomes in methadone maintenance or cocaine and alcohol addiction programs. These studies have shown consistently that psychosocial treatments are helpful for patients with addictive disorders, with an effect size that ranges from mild to moderate. Major studies of psychotherapy in the treatment of addictive disorders are reviewed, and background information on psychotherapy and drug counseling is presented.

Effects of a comprehensive rehabilitation program on quality of life in patients with chronic heart failure.

This evaluation was performed to assess the effects of a new, comprehensive outpatient rehabilitation program on generic and disease-specific quality of life related to exercise tolerance in stable chronic heart failure patients. Fifty-one patients (aged 59+/-11 years; 84% men) were treated for 12 weeks. Patients underwent optimized drug treatment, exercise training, and counseling and education. At baseline and at the end of the program, functional status, exercise capacity, and quality of life were assessed using the Medical Outcomes Study 36-item Short-Form Health Survey and the Minnesota Living with Heart Failure Questionnaire. Left ventricular ejection fraction and New York Heart Association functional class, as well as measures of physical fitness and walking distance covered in 6 minutes, improved significantly (by 11%-20% and by 58% on average, respectively). Physical functioning (effect size, 0.38; p<0.0001), role functioning (effect size, 0.17; p<0.05), and mental component score (effect size, 0.47; p<0.0001) on the questionnaire improved significantly. Disease-specific quality of life improved in sum score (effect size, 0.24; p<0.0001) and physical component score (effect size, 0.35; p<0.0001). The latter was inversely correlated to improvement in peak power output (r= -0.31; p<0.05). In patients with stable chronic heart failure, significant improvements in both generic and disease-specific quality of life related to improved exercise tolerance can be achieved within 12 weeks of comprehensive rehabilitation.

Impact of IMCI training and language used by provider on quality of counseling provided to parents of sick children in Bougouni District, Mali

This study evaluates the impact of the Integrated Management Of Childhood Illness (IMCI) training on quality of counseling provided to caregivers about administration of antimalarials to their children. Ten community health centers in southern Mali were randomized to either training or comparison arms of the study, and health providers’ consultations with caregivers were observed. Out of a 10-point counseling scale (Cronbach’s α =0.77), IMCI-trained providers completed an average of 1.47 (95% CI, −0.25, 3.2) more tasks than did providers who had not received IMCI training in a linear regression analysis that accounted for intra-provider correlations. Drug consultations done in both French and the local language, Bambara, had higher scores than those conducted exclusively in Bambara. The effect of providers receiving IMCI training was more pronounced in bilingual consultations, with an average increase of 2.49 (95% CI, 0.76, 4.22) in IMCI, bilingual consultations, and average increase of 0.87 (95% CI, −0.95, 2.69) in IMCI monolingual (Bambara) consultations as compared to non-IMCI-trained providers in monolingual consultations. IMCI training showed a non-significant trend overall in improving drug counseling provided to caregivers, with significant improvements in bilingual consultations. The IMCI program in Mali should consider strategies such as role-playing of counseling in Bambara or other local languages during training to improve patient–provider communication. Similar problems related to counseling by health workers in local languages are likely to be present throughout Africa, and warrant further study.

Chemical Dependency Counseling, A Practical Guide.: By Robert R. Perkinson. Sage Publications, Thousand Oaks, CA. 2nd edn: 2002, 544 pp., pound39.00. ISBN: 0-7619-2388-8.

The book’s author, Robert R. Perkinson, is a licensed psychologist and a certified alcohol and drug counsellor who is Clinical Director of the Keystone Treatment Centre in South Dakota. The book is intended as a standard training text for those in the addiction field, which in America, is 12-step orientated. The author describes treatment as a ‘spiritual journey’ and examines the importance of the ‘higher power’ in supporting patients through steps …

Counselling and Coping

Journal of Advanced NursingVolume 42, Issue 4 p. 424-424 Counselling and Coping Eddie Orme, Eddie Orme Simpson House Drug Counselling and Related Services, Edinburgh, UKSearch for more papers by this author Eddie Orme, Eddie Orme Simpson House Drug Counselling and Related Services, Edinburgh, UKSearch for more papers by this author First published: 06 May 2003 https://doi.org/10.1046/j.1365-2648.2003.02680_2.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume42, Issue4May 2003Pages 424-424 RelatedInformation

Pharmaceutical services in rural hospitals in Illinois--2001.

The results of a survey characterizing pharmaceutical services in rural hospitals in Illinois are reported and compared with results of a similar survey conducted in 1991. A questionnaire was developed and mailed to pharmacy directors at rural hospitals in Illinois to obtain information about product-related services, the use of technology, clinical pharmacy services, and human resources data (including vacancies) for 2001. Of the 71 surveys that were mailed, 47 pharmacy directors (66%) responded. Respondent hospitals were smaller compared with those responding in 1991 (mean average daily census, 41.0 versus 51.2, respectively). As in 1991, nearly all respondents reported the provision of unit dose services and complete and comprehensive i.v. admixture programs (100% and 83%, respectively, for 2001). Three respondents (6%) reported having a cleanroom facility. The most commonly used technology reported was nursing-unit-based automated drug dispensing cabinets (35%). Nearly all hospitals reported providing drug therapy monitoring, patient education and counseling, pharmacokinetic consultations, and nutritional support. Consistent with national reports, staffing levels and vacancies increased between 1991 and 2001. In 2001, the mean number of full-time equivalents was 7.1, with a pharmacist to technician ratio of 1.0:1.08 and a ratio of pharmacists to occupied beds of 1.0:22.6. The overall vacancy rate was 8%, with a vacancy rate of 14% and 5% for pharmacists and pharmacy technicians, respectively. A 2001 survey of pharmacy departments in rural hospitals in Illinois showed progression in the provision of distributive and clinical pharmacy services since 1991. Employee vacancy rates in pharmacy departments were high in 2001, especially among pharmacist positions, but were lower than those reported for the general population of hospitals.

America's urban crisis a decade after the Los Angeles riots

The Los Angeles Times published a weeklong series of front-page articles reviewing the day the riots erupted, assessing contemporary conditions in the riot corridor, and examining the current state of race relations in America’s most racially diverse city. Reporters interviewed academic experts, community activists, ordinary residents, business leaders, and others; and the paper sponsored a public opinion poll to probe how Angelenos now felt about their city. But the paper’s most telling story was buried on page 20 on the day of the anniversary,April 29. The headline was “Tax Cut Clouds Bush’s Urban Agenda.” Bush came to Los Angeles that day to speak at a church-sponsored community development center at the 1992 riot’s epicenter,South Los Angeles—an area with almost 700,000 residents, bigger than most cities. Reporters might have expected him to announce a new initiative to address the nation’s serious urban problems,but instead he simply touted his most visible urban program— encouraging urban churches to sponsor social programs such as homeless shelters,food kitchens,and drug counseling. His proposal (which has been stalled in Congress because of disagreements over federal funding for religious activities) added no funds for these worthy,though Band-Aid,efforts,but simply called for redirecting existing moneys. Also,by pushing $1.3 trillion in tax relief, mostly for the wealthy,Bush made it impossible for the federal government to provide any significant aid to the nation’s cities or to the poor.

The expected role of community pharmacist in society

With recent advances in the separation of dispensing and prescribing drugs (Bungyo), the social role of community pharmacists has expanded. Therefore we carried out a questionnaire survey on the "image of community pharmacists" among patients/the public, physicians, and community pharmacists. The understanding of their role by community pharmacists differed slightly from that by patients/the public or physicians. Better mutual understanding among the three parties is necessary for smooth communication. Dispensing and handing over drugs to patients are not the only tasks required of community pharmacists. Evaluation of records of telephone drug counseling by the Japan Pharmaceutical Association revealed that many callers desired not only drug information but also the opinions and judgments of pharmacists. Providing drug information is an important task for community pharmacists. In addition, counseling on anxiety and worries about health may be necessary. Bungyo has also affected drug distribution. In this field, the role of community pharmacists in providing drug information may markedly change in the future.

Relation of Premorbid Cognitive Abilities to Substance Users' Problems at Treatment Intake and Improvements with Substance Abuse Treatment and Case Management

Substance users' premorbid cognitive skills and abilities, assessed by their scores on standardized achievement tests (Iowa Tests of Basic Skills) during the fourth grade of elementary school, were examined as predictors of their problems at treatment intake and improvements with substance abuse treatment and case management over a 12‐month follow‐up period. Clients were assigned to four groups differing in the type of case management provided. Among 213 clients meeting criteria for the study, problems in several areas at treatment intake (assessed by the Addiction Severity Index) were milder for those with higher, relative to lower, premorbid cognitive abilities. Relationships of premorbid cognitive abilities to improvements at follow‐ups were more prominent for clients who worked with case managers primarily via telecommunications than for clients who generally met with case managers at the substance abuse treatment or an independent agency, or who received only limited case management services from primary drug counselors. Thorough utilization of an interactive voice response system available to the telecommunications group might have placed demands on cognitive abilities that were less emphasized in the other groups. Alcohol differed markedly from other drugs in how improvements in problems were related to premorbid cognitive abilities among clients in the telecommunications group, and, to a lesser extent, among clients who generally met with case managers in person. Premorbid cognitive abilities should be considered when examining how outcomes are related to clients' characteristics and how maximally effective treatments can be selected based on clients' characteristics.

Retention in psychosocial treatment of cocaine dependence: predictors and impact on outcome.

This report describes retention in treatment in the National Institute on Drug Abuse Collaborative Cocaine Treatment Study (CCTS), a multi-site trial of four psychosocial treatments for 487 cocaine dependent patients. Younger, African-American, and unemployed patients were retained in treatment for fewer days than their counterparts. African-American patients who lived with a partner were retained in treatment for less time than if they lived alone. Higher psychiatric severity kept men in treatment longer but put women at risk for dropping out sooner. Patients who completed the full treatment used drugs less often than patients who dropped out, but outcome did not differ at each month. Patients in the drug counseling condition stayed in treatment for fewer days than patients in psychotherapy, but they were more likely to be abstinent after dropout. Patients with higher psychiatric severity were more at risk for continuing to use drugs after dropout.

AACAP Urges Alternatives For Troubled Youth

AACAP Urges Alternatives For Troubled Youth

Nonprescription drug-related problems and pharmacy interventions.

To document the number and types of drug-related problems (DRPs) identified in customers purchasing nonprescription products in Swedish pharmacies; describe the distribution of DRPs by customer's gender, age, underlying ailment, and class of drug; determine whether problems are identified to the same extent in pharmacies with staffed nonprescription self-service departments as in pharmacies with over-the-counter sales; and document the number and types of pharmacy interventions to prevent or resolve DRPs, including reasons for drug switches and referrals to physicians. A computerized instrument for documentation of DRPs and pharmacy interventions was developed. The study was conducted in 45 volunteer pharmacies in Sweden during 10 weeks in late 1999. A total of 1,425 problems and 2,040 interventions were recorded by 308 pharmacy practitioners. Relatively fewer DRPs were documented in pharmacies with self-service departments. The most common DRPs were uncertainty about the indication for the drug (33.5%) and therapy failure (19.5%). Dyspepsia was the most frequently specified symptom (11.4%). Consumers of dermatologic products had significantly higher rates of problems than expected in relation to sales volume. The most common ways of responding to a problem were with consumer drug counseling (61.1%), switching of drugs (43.9%), and referral to a physician (27.5%). The study has demonstrated a need for more professional attention and intervention by pharmacy staff to prevent and rectify DRPs in nonprescription consumers. It seems especially important to make sure that consumers receive the appropriate drugs for their current ailments.

Relationship Between Service Utilization and Runaway Youths' Alcohol and Other Drug Use

Runaway youths represent a vulnerable, high-risk population that has received little societal attention. Studies show that youths at greatest need are the least likely to access mental health, medical, and other social services. This study evaluated service utilization, including medical visits, psychological, alcohol and drug counseling and 12-step attendance, and substance use. Runaway youths (n = 51) between the ages of 12 and 17 with a diagnosis of alcohol abuse or dependence were recruited from two southwestern runaway shelters. Results showed that psychological counseling and medical visits were associated with less alcohol use while 12-step attendance was associated with more alcohol use at pretreatment. Service utilization was not associated with illicit drug use. The findings suggest that alcohol and other drug use are affected differently by service utilization in this sample of youths. More research is required to evaluate and develop treatments which can effectively intervene with this high-risk group.

U.S. Federally Funded Television Public Service Announcements (PSAs) to Prevent HIV/AIDS: A Content Analysis

This article reports a content analysis of 56 English-language public service announcements (PSAs) for HIV/AIDS prevention produced since 1987 by the U.S. federal government for television broadcast. These PSAs do not lead target audiences through a logical sequence from awareness to motivation, skill building, and maintenance. The PSAs underutilize a strategy of ''strategic ambiguity'' to craft individual PSAs that can address the needs of and appeal to multiple target audiences, thereby directing information not only to heterosexuals, the primary target of these PSAs, but also to homosexuals and bisexuals. The PSAs largely ignore issues related to injection drug use and needle sharing. What drug-related portrayals there are focus on African American street junkies, which perpetuates racial stereotypes and fails to address occasional injection drug use. The PSAs exploit fear of HIV/AIDS to discourage drug use but do not offer drug treatment or counseling information. PSAs produced by the Clinton administration to promote condom use do not fully address key reasons why people fail to use condoms: concern about sexual pleasure, embarrassment about obtaining condoms, and lack of skills to negotiate condom use with sexual partners. Implications of these conclusions for the future of U.S. HIV/AIDS prevention are discussed.