Drug Counseling Research Articles

Naltrexone and relapse prevention treatment for cocaine-dependent patients

A double-blind, placebo-controlled clinical trial examining the joint action of naltrexone (NTX) in combination with relapse prevention (RP) therapy for the treatment of cocaine dependence was conducted. Eighty-five participants who achieved initial abstinence during the intake evaluation and detoxification phase of the study were randomized into 1 of 4 combined NTX (0 vs. 50 mg) by therapy (RP vs. Drug Counseling) experimental conditions for the 12-week outpatient treatment phase of the study. A random effects regression model to test for group differences on percentage of cocaine-positive urines indicated a significant time by medication by therapy interaction, suggesting less cocaine use over time among subjects receiving RP-50mg than those in the other conditions. No differences were found for retention or time until first cocaine-positive urine. Naltrexone was well tolerated by participants, with acceptable rates of medication compliance observed. Treatment integrity measures confirmed successful manipulation of the psychotherapy. These results are consistent with the notion that substance use in dependent patients can be reduced with a combination of coping skills training and pharmacologic treatments.

Alcoholism: beliefs and attitudes among Canadian alcoholism treatment practitioners.

To explore differences in views concerning adjunctive medications and theoretical orientation among Canadian practitioners from different professional backgrounds who treat alcoholism. A survey of clinicians from different disciplines was conducted by mail. The response rate was 56%: 95 drug and alcohol counsellors, 46 social workers, 81 nonpsychiatrist addiction physicians, and 74 addiction psychiatrists. The number of items in the questionnaire was reduced using principal component analysis. Group differences were explored using analysis of variance with Bonferroni correction and Scheffé's posthoc comparisons. Physicians and nonphysicians differed in their views on the utility of medications in treating alcohol problems, the disease concept of alcohol problems, and the classification of alcohol abuse or dependence as psychiatric conditions. No group differences emerged on views regarding cognitive-behavioural treatment, pharmacological-only interventions, combined treatment, and recovery without treatment. Psychopathology in the alcoholic was significantly more likely to be considered as secondary to the use of alcohol by nonpsychiatrist physicians. Nonphysician practitioners viewed alcoholic behaviour as self-medication. Groups differed on questionnaire items concerning medication use and the disease concept of alcoholism. Agreement on several areas may facilitate bridging the gap across disciplines. The implications of these results are discussed.

A Resource for Addiction Counseling: Licensed Chemical Dependency Counselors in Texas

Licensed Professional Counselors (LPCs) and school counselors increasingly find themselves asked to work cooperatively with Licensed Chemical Dependency Counselors (LCDCs) in a variety of work settings. This article addresses the scope of practice of LCDCs, their current licensing requirements, and some misconceptions about the alcohol and other drug (AOD) counseling field. Unfamiliarity with the role of the LCDC, combined with misunderstandings about the AOD field may prevent productive working relationships between mental health professionals and LCDCs. This may interfere with providing quality service to the many clients who present with AOD issues.

Should community-managed drug stores be phased out?

The existence of community-managed drug stores (CDS), operated by trained village health workers under the supervision of health officials, is under threat in the Philippines. This is to determine if there is an association between households' access to medicines and three types of CDS, namely, Botika Binhi (BB), Family Health Management By and For Urban Poor Settlers Pharmacy (FAMUSCY) and Botika ng Barangay (BnB) in selected urban and rural communities in a province where all three types operate. The study design was case-control using structured interviews and observations. A total of 1,710 households or 90% of the total were interviewed, and the medicines at home were inspected. Indicators for the five dimensions of access are affordability, availability, A1 quality, acceptability and appropriateness. The village with the longest-running CDS for each type was selected. There is an association between the presence of any of the three CDS and villagers' perception of affordability of medicines, between FAMUSCY or BnB and availability of unbranded medicines at home as well as perception of counselling provided by prescribers and dispensers to be more than expected. On the contrary, there is an inverse association between the presence of FAMUSCY and availability of herbal plants at home, between BnB and percent of correct uses of medicines at home, and between either FAMUSCY or BnB and perceptions of availability of medicines and quality of services by dispensers at patronized drug outlets. Phasing out CDS should be weighed against the benefit of making medicines affordable at the village level, promoting the use of unbranded medicines and herbal plants with recognised therapeutic value, and keeping the clients informed through drug counselling provided by prescribers and dispensers.

The transfer of harm-reduction strategies into prisons: needle exchange programmes in two German prisons

In Autumn 1995, the Minister of Justice of Lower Saxony (a northern state of Germany) gave the green light for the implementation of a 2-year pilot project. This project provided for the distribution of sterile injection equipment and provision of communicative methods of prevention to drug addicted inmates in a women’s prison with 170 inmates (Vechta) and a men’s prison with 230 inmates (Lingen). The decision to go ahead with the project was based on positive experiences in Swiss prisons and the supporting recommendations of a panel of experts. The pilot project in Vechta started on 15 April 1996, using five dispensing machines which allow a needle exchange to guarantee an anonymous access. The project in the men’s prison started on 15 July 1996. Here the staff of the drug counselling service and of the health care unit hand out sterile syringes to inmates. The social scientific evaluation was carried out by the Carl von Ossietzky University in Oldenburg. The study focused on the aim of the project which is to assess the feasibility, usefulness and efficacy of the measures undertaken. Of special interest was whether and how changes occured in the prison system itself (i.e. acceptance of the measures by staff, medical service and management), and in the drug user’s behaviour and knowledge (i.e. development of needle sharing, change in drug use patterns). The study used a multi-methodological approach: documentation of the project practice, half standardized, longitudinal examination of inmates ( n=224) and staff ( n=153), qualitative examination of management, selected groups of prisoners, staff and external organisations (AIDS-Help-Groups; n=75) for at least two times. The evaluation intended to be dynamic, process accompanying, in order to communicate the empirical data and developments with the practice already during the pilot phase. Results of the final report of the study are presented here. Finally this paper discusses shortly what is known so far about the impact of needle exchange programmes in prisons in Germany and Switzerland.

An ethical code for AOD faculty: a proposed set of guidelines.

Ethical codes of conduct are accepted requirements for membership in state and national organizations that grant credentials to those who are employed as alcohol and other drug (AOD) counselors, prevention specialists, and clinical supervisors. It seems appropriate to explore the possibility of an ethical code directly linked to addiction faculty which will outline their unique educational responsibilities and standards. The authors suggest development and adoption of such an ethical code for college-level addiction studies faculty and this proposal is offered as a move toward that possibility.

From Chocolate to Morphine: Everything You Need to Know about Mind-Altering Drugs

a pressurized tank; consider eatingmari¬ juana instead of smoking it; do not ex¬ perimentwith hallucinogenicmushrooms without advice from an experienced per¬ son; and if you eat nutmeg or mace in an effort to get high, be prepared for a ter¬ rific hangover the next day. The authors claim to be neutral about drugs. Our intention is not to encourage drug use by anyone, nor is it to discourage drug use. Sometimes the book seems to encourage more than discourage. A 36year-old drug counselor says that Quaalude taken on occasion in a respon¬ sible manner... seems to be safe and interesting and gives me an experience different from anything else. A 17-yearold woman says there is nothing like a heroin rush. started shooting heroin when I was 14. It's just the most intense, wonderful feeling. Although full cover¬ age is given to the bad effects of drugs, the good effects sometimes sound terrific. The book is written for young people, with the hope their parents will dip into it. Its aim is to present the truth about drugs. It does not always succeed. On page 1 it says more people are taking

Individual drug counselling plus group drug counselling was effective in patients with cocaine dependence

Crits-Christoph P, Siqueland L, Blaine J, et al. Psychosocial treatments for cocaine dependence: National Institute on Drug Abuse Collaborative Cocaine Treatment Study . Arch Gen Psychiatry1999 Jun; 56 : 493...

Drug Counseling Service in a Pharmaceutical Company

Drug Counseling Service in a Pharmaceutical Company

Combining Drug Counseling Methods Proves Effective in Treating Cocaine Addiction

Combining Drug Counseling Methods Proves Effective in Treating Cocaine Addiction

Effect of antidepressant drug counselling and information leaflets on adherence to drug treatment in primary care: randomised controlled trial

Objectives: To evaluate two different methods of improving adherence to antidepressant drugs.Design: Factorial randomised controlled single blind trial of treatment leaflet, drug counselling, both, or treatment as usual.Setting: Primary care...

Drug counselling improves adherence to antidepressants

Drug counselling improves adherence to antidepressants

Compliance and medication knowledge among elderly Japanese home-care recipients.

To investigate the risk factors for noncompliance in elderly home-care recipients; and to evaluate to what extent regular home visits and drug counseling by a pharmacist contribute to compliance. One hundred and sixty-three elderly home-care recipients aged 62 years and over took part in this study. All subjects were cognitively normal, and taking a regimen of one or more prescribed drugs. Medication use was observed by pharmacist-conducted interviews during home visits. Compliance was estimated by comparing prescribed regimens with medications actually being taken at home. The mean age with (SD) of the subjects was 78.7 (8.3) years. Eighteen per cent were regularly counseled by a pharmacist about medication. Poor compliance with prescribed medications was associated with subjects aged 80 years and over, who were administering their own medication, consuming less than three meals a day, did not have one dose packages, and who were not receiving pharmacist counseling. In multiple logistic regression analyses, frequency of meals (OR 5.99; 95% CI 1.25-28.79), pharmacist counseling (OR 5.32; 95% CI 2.00-14.20), and age (OR 0.96; 95% CI 0.92-1.00) were independent predictors of good compliance for home-care recipients with physical disabilities. Compliance correlated inversely with knowledge of drug names, and drug purposes in the uncounseled group. Compliance, however, positively correlated with knowledge of drug purposes in the counseled group. In this study, compliance among elderly Japanese home-care recipients was found to be associated with receiving pharmacist counseling, frequency of meals, and age.

Use of Standardized Patients to Evaluate the Physicians in Residence Program

The purpose of this study was to evaluate the efficacy of the Physician in Residence (PIR) program at the Hazelden Residential Program of New York City as a substance abuse training approach using standardized patients (SP) and self-report ratings. Using an objective rating scale, two experienced drug counselors evaluated four videotaped interviews carried out by housestaff pre- and post-enrollment in the PIR program. In addition, housestaff completed self-report ratings regarding their knowledge, attitudes, and skills of substance abuse. Of the 23 housestaff who completed both pre- and post-PIR program videotape sessions, significant improvements were noted in both observer and self-reported ratings. Overall, self-report ratings showed a greater percent improvement than the counselor ratings. The PIR program may be an efficacious approach to teach substance abuse clinical skills to housestaff.

Therapeutic alliance as a predictor of outcome in treatment of cocaine dependence

Cocaine dependent outpatients (N = 252) were randomly assigned to one of three individual treatments (cognitive, dynamic therapy, or drug counseling) as part of the training phase of the National Institute of Drug Abuse Cocaine Collaborative Treatment Study. Patients and therapists completed the Helping Alliance (HAq-II) and the California Alliance Scale (CALPAS), which documented generally high alliance. Although patient reports of the alliance did not predict outcome on drug related measures at the sixth month assessment, it did at the one month assessment. Alliance, however, predicted improvement in depressive symptoms at six months. Overall, therapist ratings of the alliance were less often predictive of outcome than patient ratings. Results were similar across the completer and the intent-to-treat samples. The CALPAS, but not the HAq-II, predicted attrition. There was preliminary evidence that higher alliance predicted more change in depressive symptoms in patients who remained for a longer time in t...

Therapeutic selection during an emergency response.

Therapeutic selection in a postdisaster setting is described. Therapeutic selection is the process of assessing a patient's pharmaceutical requirements and selecting the appropriate therapy. Although the primary criteria for drug selection during a disaster response are the same as in usual pharmacy practice, there is a shift in emphasis created by communication and transportation limitations and by changes in the patient's general living environment. The cost of agents is no longer viewed in terms of dollars but in the context of limited inventories. A disaster may exacerbate health problems or make adverse drug effects more common and problematic. Drug administration and patient compliance will be hampered. Pre-established guidelines for appropriate patient care should be reviewed and approved by a group of representative health care providers. General policies for pharmaceutical care should include guidelines for a formulary, prescription refills, dispensing limitations, and prescriber approval. Therapeutic selection should involve obtaining a medical history, selecting a drug regimen, educating and counseling the patient, and documenting the process. Pharmacists should use familiar procedures that they are comfortable with to minimize stress and optimize outcomes. Procedures should be flexible to adjust to circumstances and individual patient needs. Therapeutic selection during a disaster response, although based on the same principles as traditional therapeutic selection, is more complex. Pharmacists will need to tailor their approach to the circumstances and to individual patient needs.

Development of pharmaceutical care in The Netherlands: pharmacy's contemporary focus on the patient.

To describe how developments in the pharmacy profession in The Netherlands converged into the current movement toward pharmaceutical care. Dutch community pharmacy. Literature was reviewed for key elements of pharmacists' professional development over the last 40 years--the pharmacist-physician relationship, the pharmacist-patient relationship, the education of the pharmacist, provision of information to patients, medication surveillance, clinical pharmacy, and social pharmacy. Consideration was given to how, when and if these elements interacted and contributed to the movement toward pharmaceutical care. During the early years of the 20th century the professional role of the pharmacist, based on preparing medications, declined because of the increased industrial production of drugs. In The Netherlands, a number of developments, starting around 1995, led to a "reprofessionalization" movement in pharmacy, characterized by pharmacists' increased awareness of social and ethical responsibilities with respect to drugs and patients. These developments included an improved relationship between pharmacists and physicians, the implementation of clinical pharmacy and medical surveillance in daily community pharmacy practice in the 1970s and 1980s, and the increased awareness of the rights of patients to quality drug information and counseling in the 1980s and 1990s. By the end of 1980 these trends had coalesced into a professional movement supporting the need for a pharmaceutical care model of practice. Dutch pharmacy is gradually implementing pharmaceutical care in daily community practice. However, a proactive attitude, not only from the "front runners," but from all pharmacists, is desirable if pharmaceutical care is to be incorporated into routine community practice.

Individual differences and choice of information source: Sensation seeking in drug abuse prevention

This study examined the relationship between sensation seeking and the information source an individual may select to (1) find exciting alternatives to drugs and (2) resist peer pressure to use drugs. Both high and low sensation seekers chose friends as the most preferred source of information. However, high sensation seekers, compared to low sensation seekers, were less likely to: talk with friends, parents or co‐workers; visit a drug counseling center; call an 800 hotline: contact a club, social group, or church group for prevention information. Low sensation seekers who used drugs, compared to high sensation seekers who used drugs, indicated a much higher preference for talking with parents. Implications for prevention efforts are discussed.

Accessibility and perceived value of health services in five western Illinois rural communities.

The purpose of this study was to determine the accessibility and perceived value of health services in five selected rural communities in South Fulton County, Illinois. The Health Services Accessibility and Value Scale (HSAVS) component of the larger Fulton County Health Care Survey was used in the investigation. The 12 items comprising the HSAVS surveyed participant perceptions relative to medical, dental, nursing, and public health department services available to them as rural residents. The HSAVS was completed by 1709 subjects. The reliability of the HSAVS was assessed by computing coefficient alpha. The scale had acceptable internal consistency reliability (alpha = .7884). To examine the construct validity of the scale, a principle component factor analysis was completed. This analysis resulted in a four factor solution which accounted for 66.6% of the cumulative total variance. Item means were calculated and were used to rank the HSAVS statements. Emergency and primary medical services were valued the most by the survey participants. Relatively high in importance to the rural residents surveyed were access to pharmacy, eye care, dental care, and immunization services. Availability of home health care, transportation to and from health care facilities, and access to mental health services were considered to be of lesser value to persons living in the rural area studied. Of least importance were alcohol and other drug counseling services, prenatal care/well baby services, and family planning services. HSAVS total scores and individual statements were also analyzed by sex, age, place of residence, and income and the results were reported.

A lasting public health response to an outbreak of HIV infection in a Scottish prison?

Between April and June 1993, 8 cases of acute clinical hepatitis B infection and 2 seroconversions to HIV infection were detected among drug injecting inmates of HM Prison Glenochil in Scotland. To prevent the further spread of infection, an initiative which involved counselling and voluntary attributable HIV testing was conducted over a 10-day period commencing at the end of June. A team of 18 counsellors and phlebotomists was brought together rapidly as part of a unique organizational exercise in the field of public health. Fourteen cases of HIV infection were identified of which 13 were almost certainly infected in Glenochil. Following the exercise, a range of harm reduction measures for injecting prisoners was introduced; these included the availability of hepatitis B vaccine, provision of bleach tablets which could be used to clean injecting equipment, a methadone detoxification programme, increased training for prison officers and improved access to drug and harm minimization counselling for inmates. By mid-1996 all these measures had been sustained and several could be found in many other prisons throughout Scotland. Follow-up investigations showed no evidence of epidemic spread of HIV during the 12 months after the initiative. While the frequency of injecting and needle/syringe sharing may have decreased over the last 3 years, these activities are still being reported and it is highly likely that transmissions of bloodborne infections, in particular hepatitis C, continue to occur. The surveillance and prevention of infections associated with injecting drug use in the prison setting remain a high public health priority.