Intensive Outpatient Treatment Program Research Articles

Change in “resolved plans” and “suicidal ideation” factors of suicidality after participation in an intensive outpatient treatment program

Background This study aims to investigate factors related to suicide in a unique clinical population with more chronic psychopathology than many outpatient samples. Method One hundred and five adult outpatients were included in the current study. We predicted that higher scores on the resolved plans and preparation (RPP) factor of the Beck Suicide Scale [Beck, A.T., Kovacs, M., Weissman, M., (1979). Assessment of suicidal intention: The scale for suicidal ideation. Journal of Consulting and Clinical Psychology 47, 343–352] would predict multiple attempter status even after accounting for co-morbid diagnoses and suicidal ideation (SI) factor scores. Additionally, we predicted that the scores on the RPP factor would decrease less over time than scores on the SI factor. Results and conclusions Results were consistent with both hypotheses, suggesting that RPP factor scores were uniquely predictive of status as a multiple attempter and were more stable over time. Limitations Mental health diagnoses were rendered without the use of a structured interview and therefore no reliability data were collected.

Intensive trauma therapy of PTSD and dissociation: An outcome study

An intensive outpatient treatment program was developed to treat posttraumatic patients referred from distant areas where the needed treatment was not available. This report addresses the question, “Is it possible to effectively treat patients with PTSD and/or dissociative disorders in a brief outpatient program of 1 or 2 weeks?” The treatment methods relied heavily on art therapy, hypnosis, and video therapy. This was a naturalistic study with pre- and post-test data on the first 72 patients who completed the program. Forty-five percent of the participants met criteria for recovery, 44% were improved, 8% were unchanged, and 3% were worse after treatment. The improvement in scores on the post-treatment measures was robust and statistically significant for all groups of patients. Brief intensive outpatient trauma therapy appears to be a feasible treatment for posttraumatic disorders. There was no significant difference between the various diagnostic categories in terms of improvement or recovery.

Personality Disorder and Chronicity of Addiction as Independent OutcomePredictors in Alcoholism Treatment

Personality Disorder and Chronicity of Addiction as Independent OutcomePredictors in Alcoholism Treatment

Cell phones for ecological momentary assessment with cocaine-addicted homeless patients in treatment

This is the first study to examine whether cell phones could be used to collect ecological momentary assessment (EMA) data with homeless crack cocaine-addicted adults in treatment. The study adapted an EMA method to examine behavior in real time using cell phones and computer-automated telephone interviewing. Participants treated in an intensive outpatient treatment program were given cell phones for a 2-week period to record current states of cocaine craving and using episodes. Results showed cell phone technology could reliably deliver a computerized survey; this homeless population would use a cell phone to report craving and using episodes, and drug use reported via EMA was in agreement with urine toxicology results for 73% of participants. Of 30 participants, 24 (80%) completed the full 2-week protocol. Participants indicated the survey made them more aware of phenomena leading to cravings and use, suggesting the usefulness of EMA as a potential intervention.

Impact of different personality dimensions (NEO Five-Factor Inventory) on the outcome of alcohol-dependent patients 6 and 12 months after treatment

There is growing evidence that outpatient treatment might be equally effective as inpatient treatment for alcohol-dependent patients. Nevertheless, it is still unclear which patient group benefits most from outpatient treatment. Some personality traits such as emotional instability and high neuroticism are known risk factors for relapse after treatment. The purpose of the following study was to investigate the possible relationship between personality traits, measured by the NEO Five-Factor Inventory (NEO-FFI), and outcome after an intensive outpatient treatment program. Seventy-four alcohol-dependent patients who had completed the outpatient treatment program were included. Patients were examined at the beginning and end of the treatment, and 6 and 12 months after completion of the treatment. At the 6- and 12-month follow-up, 97% of the patients were successfully located and personally interviewed. Analyses revealed that 54 patients (73%) had been abstinent for the entire 12-month follow-up period. Twenty patients (27.4%) were found to be non-abstinent. Of these patients, 10 (13.5%) were found to be improved and 10 (13.5%) to have relapsed. Results indicate a remarkable stability of NEO-FFI scores over time, giving evidence for the usefulness of this instrument for the assessment of personality dimensions in alcohol-dependent patients. Patients who relapsed within 12 months after treatment had significantly higher scores on the personality domains of “neuroticism” and lower scores on the personality domains of “conscientiousness” than abstainers. These results are in line with prior research on this topic.

Predictors of Relapse During Treatment and Treatment Completion Among Marijuana-Dependent Adolescents in an Intensive Outpatient Substance Abuse Program

ABSTRACT The present study assessed possible predictors of relapse while in treatment and treatment completion among marijuana-dependent adolescents (N = 59) in an intensive outpatient substance abuse treatment program. Comorbid depression was associated with an increased likelihood of relapse and a higher total number of relapses. As expected, relapse while in treatment was associated with a reduced likelihood of successfully completing the treatment program. Comorbid attention deficit hyperactivity disorder (ADHD) was also associated with a lower likelihood of successful program completion. These findings add to a slowly growing literature regarding adolescent substance abuse treatment, and may help clinicians identify marijuana-dependent adolescents at greater risk of relapse or noncompliance.

Pre—Treatment Measures of Impulsivity, Aggression and Sensation Seeking Are Associated with Treatment Outcome for African—American Cocaine—Dependent Patients

We investigated whether measures of impulsivity, aggression and sensation seeking differed between cocainedependent subjects and controls, and whether these measures were related to treatment—outcome for cocaine patients. Pretreatment assessments of impulsivity (Barratt Impulsivity Scale [BIS]), aggression (Buss-Durkee Hostility Inventory [BDHI]) and sensation seeking (Zuckerman Sensation Seeking Scale [SSS]) were obtained for 141 African—American cocainedependent patients entering a 12-week, intensive outpatient treatment program and 60 controls. The outcome measures were number of negative urine drug screens, days in treatment, dropout rates and number of treatment sessions. Cocaine patients reported significantly higher scores on the SSS, the BIS and the BDHI than controls. Furthermore, the SSS scores showed a significantly negative correlation with days in treatment and negative urines, and a significant positive correlation with the drop—out rate. The BIS and the BDHI scores were significantly associated with days in treatment and dropout rates respectively. A combination of the three variables contributed significantly toward predicting retention and abstinence. Higher levels of pretreatment impulsivity and aggression and sensation seeking seem to associated with poor treatment outcome for cocaine dependent patients receiving intensive outpatient treatment. Combining these behavioral measures with other clinical predictors may help in early identification of 'poor responders' who may benefit from additional or alternative treatment approaches.

Chronic addiction relapse treatment: a study of the effectiveness of the high-risk identification and prediction treatment model. Part III. Conclusion and future implications of HRIPTM research.

The high-risk identification and prediction treatment model (HRIPTM) was developed to investigate physiological and psychological conditions associated with the concept of negative emotional state, and to examine the origin and evolution of this condition in relation to addiction relapse. An in depth case study sample of N=30 was conducted within the context of an intensive outpatient addiction treatment program based on the HRIPTM. The HRIPTM investigates the nature of problematic repetitive behavior patterns originating in the childhood developmental period, the individual nature of negative emotional state in relation to these patterns and their evolution, and their influence on addiction vulnerability and addiction relapse. The preliminary study on which this model was based emphasized the importance of developing methods for accumulating information that pinpoints life span experiences associated with the origin of problematic behaviors, the level of emotional intensity factors associated with behavior pattern construction and development, and the level of associated risk potential as it manifests in each individual case. Recent neuroscientific studies into the early developmental process are producing increased evidence of the enormous influence of this period on later developmental processes. Addiction, in itself a developmental process, may be more influenced by pre-addiction factors than previously assumed. This model addresses those influences. The study was conducted to determine whether information that arises from the HRIPTM increases the patient's and clinician's ability to address addiction relapse more effectively. Because of the completion of the HRIPTM program, the sample n=30 reported gained ability to address recovery processes more effectively. The 12-question HRIPTM Questionnaire instrument, when tabulated, revealed that of the 360 total responses, less than 2% disagreed that ability had been gained in all suggested areas defined in the questionnaire. Over 98% agreed or strongly agreed that ability had been gained in the defined areas.

Chronic addiction relapse treatment: a study of the effectiveness of the high-risk identification and prediction treatment model. Part I.

The high-risk identification and prediction treatment model (HRIPTM) was developed to investigate physiological and psychological conditions associated with the concept of negative emotional state, and to examine the origin and evolution of this condition in relation to addiction relapse. An in-depth case study sample of n=30 was conducted within the context of an intensive out-patient addiction treatment program based on the HRIPTM. The HRIPTM investigates the nature of problematic repetitive behavior patterns originating in the childhood developmental period, the individual nature of negative emotional state in relation to these patterns and their evolution, and their influence on addiction vulnerability and addiction relapse. The preliminary study, upon which this model was based, emphasized the importance of developing methods for accumulating information that pinpoints lifespan experiences associated with the origin of problematic behaviors, the level of emotional intensity factors associated with behavior pattern construction and development, and level of associated risk potential as it manifests in each individual case. Recent neuroscientific studies into the early developmental process are producing increased evidence of the enormous influence of this period on later developmental processes. Addiction, in itself a developmental process, may be more influenced by pre-addiction factors than previously assumed. This model addresses those influences. The study was conducted to determine whether or not information that arises from the HRIPTM increases the patient's and clinician's ability to address addiction relapse more effectively. As a result of completion of the HRIPTM program, the sample n=30 reported gained ability to address recovery processes more effectively. The 12-question HRIPTM Questionnaire instrument, when tabulated, revealed that of the 360 total responses, less than 2% disagreed that ability had been gained in all suggested areas defined in the questionnaire. Over 98% agreed or strongly agreed that ability had been gained in the defined areas.

Retention Predictors Related to Intensive Outpatient Programs for Substance Use Disorders

The purpose of this research was to expand knowledge in the current literature regarding treatment retention in intensive outpatient substance abuse treatment programs. The sample in this study participated in a hospital-based program accredited by the Joint Commission on Accreditation for Health Organizations (JCAHO) that utilized the Minnesota model. Specifically, this inquiry investigated whether treatment retention would be predicted by gender, age, employment status, number of problems on the treatment plan, whether the referral was related to driving while intoxicated (DWI), marital status, race, and whether each of the following substance problems was listed as the client's primary DSM-IV diagnosis: alcohol dependence, cocaine dependence, polysubstance dependence, opioid dependence, sedative/hypnotic dependence, cannabis dependence, other (or unknown) dependence, alcohol abuse, cannabis abuse, amphetamine abuse, and caffeine intoxication. Findings indicated that those retained in treatment, when compared to those who dropped out, had significantly more problems on their treatment plans, were more likely to be alcoholics, were less often cocaine addicts, and were more likely to be employed. The results of this study suggest that clients with this profile have increased likelihood of being retained in intensive outpatient substance abuse treatment programs.

An Exploratory Attempt to Distinguish Subgroups Among Crack-Abusing African-American Women

Despite the significant emergence of research on female addiction over the last two decades, specific research on African-American women substance abusers, particularly crack cocaine users, is limited. The identification of meaningful subgroups of substance abusing populations, particularly minority women is important both clinically, and because of their over-representation in the epidemiological data on crack cocaine use in many urban centers across this country. An extensive battery of instruments was administered to 110 women entering treatment in an intensive outpatient substance abuse treatment program in Philadelphia, serving women who are primarily indigent, African-American, and whose primary substance of abuse is crack cocaine. Factor analysis and cluster analysis procedures were utilized to classify women into subgroups across relevant clinical, behavioral, and background concerns relevant to studying substance abusing populations. Five conceptually meaningful subgroups emerged which classified women across various indicators such as HIV sex risk factors, personality traits/Axis II dimensions, clinical syndromes, psychological symptomatology, lifetime and recent drug and alcohol use, prior physical and sexual abuse, and social context variables such as parental addiction, and whether they live with a substance abuser. Attempts to classify women into identifiable clinical subtypes is essential in order to better inform treatment initiatives designed to serve this group, as well as prevention and community outreach intervention strategies which attempt to bring them into treatment.

A Follow-Up Study on Chromosomal Aberrations in Lymphocytes of Alcoholics During Early, Medium, and Long-Term Abstinence

The frequencies of structural chromosomal aberrations were analyzed in peripheral blood lymphocytes of 31 chronic alcoholics at the beginning of an intensive outpatient treatment program at a neuro-psychiatric clinic and were compared with 31 controls matched for gender, age, smoking habits, and nondrinkers. A statistically significant difference was observed in the level of chromosomal aberrations in somatic cells from alcoholics when compared with controls (3.01 % vs. 1.28%, p < 0.001). A follow-up study was carried out for a subset of the patients after 3 months (8 subjects) and 12 months (14 subjects) of controlled abstinence. A statistically significant increase in the mean frequency of cells with aberrations was observed in the group of 14 subjects reinvestigated after 12 months of abstinence when compared with the mean value of the first blood samples immediately after hospitalization (4.61% vs. 3.01%; p < 0.001). An excessive increase in cigarette consumption during alcohol abstinence, reflected by a dramatic elevation of CO-hemoglobin levels, may, at least in part, account for this finding. In conclusion, chronic alcoholism leads to genotoxic effects that, instead of recovering after 1 year of alcohol abstinence, are even enhanced, most likely due to the “shift in addictive behavior.”

A Follow‐Up Study on Chromosomal Aberrations in Lymphocytes of Alcoholics During Early, Medium, and Long‐Term Abstinence

The frequencies of structural chromosomal aberrations were analyzed in peripheral blood lymphocytes of 31 chronic alcoholics at the beginning of an intensive outpatient treatment program at a neuropsychiatric clinic and were compared with 31 controls matched for gender, age, smoking habits, and nondrinkers. A statistically significant difference was observed in the level of chromosomal aberrations in somatic cells from alcoholics when compared with controls (3.01% vs. 1.28%, p < or = 0.001). A follow-up study was carried out for a subset of the patients after 3 months (8 subjects) and 12 months (14 subjects) of controlled abstinence. A statistically significant increase in the mean frequency of cells with aberrations was observed in the group of 14 subjects reinvestigated after 12 months of abstinence when compared with the mean value of the first blood samples immediately after hospitalization (4.61% vs. 3.01%; p < or = 0.001). An excessive increase in cigarette consumption during alcohol abstinence, reflected by a dramatic elevation of CO-hemoglobin levels, may, at least in part, account for this finding. In conclusion, chronic alcoholism leads to genotoxic effects that, instead of recovering after 1 year of alcohol abstinence, are even enhanced, most likely due to the "shift in addictive behavior."

A Retrospective Investigation of an Intensive Outpatient Substance Abuse Treatment Program

Outpatient treatment for chemical dependency has been found to be both clinically effective and cost efficient. The purpose of this retrospective investigation was to evaluate program completion data and variables related to attrition for an intensive outpatient substance abuse treatment program. Subjects were 488 clients enrolled in the Smithers Evening Rehabilitation Program between 1991 and 1995. Client drug preference was found to be an important factor related to treatment retention, with cocaine abusers having the highest attrition rates. In addition, increasing age was an advantage in predicting who would complete the initial phase of treatment. Implications for programmatic changes, clinical practice, and future research are considered.

Test-retest reliability of the lifetime items on the Addiction Severity Index.

Longer interval (M = 50.6, SD = 13.1 days) test-retest reliability of the lifetime items on the Addiction Severity Index (ASI), a semistructured interview, was evaluated in 108 alcohol and/or cocaine dependent patients. They were administered the ASI at admission to an intensive outpatient rehabilitation treatment program and again after completion of this intervention and randomization into an aftercare study. Results demonstrated good to excellent reliability for participants' reports for most lifetime items in the medical, employment, drug, alcohol, and legal problem areas. Two of the ASI areas, family/social and psychiatric, had numerous items that did not achieve acceptable levels of reliability. Within these two problem areas, the more subjective and less operationally defined constructs had the poorest reliability. This study, in general, supports the longer interval test-retest reliability of the ASI lifetime items as well as the notion that alcohol and cocaine dependent patients under certain conditions can and do reliably report personal information.

Predictors of attrition from an outpatient chemical dependency program1

This study investigated differences between completers and noncompleters of an intensive outpatient substance abuse treatment program to identify key predictors of attrition. Participants (n= 138) completed a comprehensive intake/assessment package that included the Addiction Severity Index as a precursor to participation in the program. Discriminant function analyses (DFA) suggested that ASI composite scores and severity ratings were not useful predictors. However, analysis of individual items was useful in identifying “red flags”; as predictors for treatment attrition. The subsequent DFA identified the following variables as significant predictors: Hispanic ethnicity, absence of a professional skill, shorter time since last hospitalization, cocaine or cannabis use in the last 30 days, total number of family members with drug problems, presence of emotional abuse in last 30 days, concern with family problems, and number of family group meetings that family members attended. These red flags can serve the important function of providing clinicians with enough information to intervene early with patients at risk for treatment dropout.

Multidisciplinary Treatment of Persistent Symptoms after Gulf War Service

Research suggests that individuals commonly describe persistent symptoms or syndromes after a war. After the Persian Gulf War, the Department of Veterans Affairs and the Department of Defense initiated registries and expedited health care for those with Gulf War-related health concerns. At Walter Reed Army Medical Center, the Gulf War Health Center was created in mid-1994 to contribute a continuum of care for those with Gulf War-related health problems. The purpose of this report is to describe the Gulf War Health Center's Specialized Care Program, a 3-week intensive outpatient multidisciplinary treatment program for people with persistent, disabling Gulf War-related symptoms. The program uses an evidence-based model of multidisciplinary care employed at chronic pain centers internationally and shown to yield stable improvements in pain, mood, health care use, and return to work rates. A patient is described to illustrate how the program works. Finally, a Deployment Medicine Treatment Center is proposed, a multidisciplinary treatment center like the Specialized Care Program that would offer care to those with persistent, disabling symptoms after all future deployments.

Mediators of drug treatment outcomes

Treatment for drug use, like the process by which a person comes to use illicit drugs, may be seen to be at least in part a psychosocial process involving emotional, cognitive, and relationship domains. Treatment programs attempt to improve the psychosocial functioning of clients with the ultimate goal of effecting change in drug-use behaviors. In a longitudinal study of clients in an intensive outpatient treatment program using a cognitive behavioral model to treat crack cocaine use, it was found that length of treatment was directly associated with improvement in emotional well-being, cognitive functioning, and relationships. Of the three psychosocial domains, improvement in relationships had the strongest effect on selfreported decreases in cocaine usage, verified by urinalysis. Improvement in cognitive functioning had a small impact on cocaine use, whereas improvement in emotional well-being had almost no independent effect in this cognitive behavioral treatment program.

MBHI hos patienter med kroniske rygsmerter

Twenty-six patients with chronic non-malignant low-back pain syndrome completed the MBHI (Millon Behavioral Health Inventory) before and after an intensive outpatient treatment program of 6 weeks' duration carried out by a psychologist, a physiotherapist, and a nurse at the Pain Clinic in Herlev, Copenhagen. Patients were contacted by telephone at half-year follow-up to evaluate any changes in the use of analgetics and the intensity of the pain. Compared with a group of patients with acute pain, the chronic pain patients were more sensitive, less confident, and less sociable. Scale PP, measuring possible psychologic factors affecting the chronicity of the pain syndrome, had a high positive predictive power (0.83) for outcome of the psychologically oriented treatment. The negative predictive power was low (0.50), no better than by chance selection. Patients doing better after treatment were better on the following scales: chronic tension, premorbid pessimism, somatic anxiety, and sociability. MBHI may be a...

Results of a Program to Reduce Admissions for Adult Asthma

To determine the effect of an outpatient program designed to reduce readmissions for asthma exacerbations among adults with asthma. Randomized patient selection with crossover. Bellevue Hospital, New York City, New York. We identified 104 adult asthmatics who had previously required multiple hospitalizations for asthma attacks. Forty-seven patients were randomly assigned to an intensive outpatient treatment clinic and 57 patients continued to receive their previous outpatient care. Nineteen patients from this latter group were then crossed to the intensive outpatient therapy clinic. Attenders of the intensive outpatient treatment program were treated with a vigorous medical regimen and educational program. Emphasis was placed on teaching patients aggressive self-management strategies in case of marked asthma exacerbation. The main measurement used to determine efficacy of the study program was readmission rate and hospital days used. Prospective comparison of treated compared with untreated patients indicated that program enrollment resulted in a threefold reduction in readmission rate and a twofold reduction in hospital day use rate (P less than 0.004 and P less than 0.02, respectively). Using retrospective data with patients serving as their own controls, we found a threefold reduction in readmission rate and in hospital day use (P less than 0.003) during a 32-month follow-up period. A similar magnitude of reduction in hospital utilization was found when patients were crossed over to the intensive treatment group (P less than 0.004). By using a vigorous medical regimen and intensive educational program, we were able to decrease hospital use among a group of adult asthmatics who had previously required repeated readmissions for acute asthma exacerbations.