Relapse Prevention Group Research Articles

Relapse Prevention Group Therapy in Indonesia Involving Peers via Videoconferencing for Substance Use Disorder: Development and Feasibility Study.

Substance use disorder (SUD) is a major health issue in Indonesia, where several barriers to treatment exist, including inaccessibility to treatment services, stigma, and criminalization of drug issues. Peer involvement and the use of telemedicine to deliver psychotherapy are promising approaches to overcome these barriers. This study aims (1) to describe the development of a new group psychotherapy coprovided by a health care worker and a peer and (2) to evaluate the acceptability, practicality, and preliminary outcomes of the program delivered via videoconferencing in Indonesia. Building upon an established relapse prevention therapy in Japan, we developed a 3-month weekly group therapy module in the Indonesian language. Adjustments were made via focus group discussions with local stakeholders in terms of substance types, understandability, inclusive language, and cultural relevance. A pilot study was conducted to test the new module provided by a peer and a psychiatrist via videoconferencing, termed tele-Indonesia Drug Addiction Relapse Prevention Program (tele-Indo-DARPP), with a pre- and postcontrolled design. We analyzed data from semistructured feedback interviews and outcome measurements, including the number of days using substances and quality of life, and compared the intervention (tele-Indo-DARPP added to treatment as usual [TAU]) and control (TAU only) arms. In total, 8 people diagnosed with SUD participated in the pilot study with a mean age of 37 (SD 12.8) years. All were men, and 7 (88%) used sedatives as the primary substance. Collectively, they attended 44 of the 48 tele-Indo-DARPP sessions. A total of 3 out of 4 (75%) preferred telemedicine rather than in-person therapy. Positive acceptability and practicality were shown from qualitative feedback, in which the participants who joined the tele-Indo-DARPP reported that they liked the convenience of joining from home and that they were able to open up about personal matters, received helpful advice from peers, and received support from other participants. Providers reported that they feel the module was provider-friendly, and the session was convenient to join without diminishing rapport-building. Meanwhile, troubles with the internet connection and difficulty in comprehending some terminology in the workbook were reported. The intervention arm showed better improvements in psychological health and anxiety symptoms. Group psychotherapy via videoconferencing coprovided by health care workers and peers was acceptable and practical for participants with SUD and service providers in this study. A large-scale study is warranted to examine the effectiveness of the newly developed module in Indonesia.

Group therapy for problematic chemsex in Ngos community treatment settings in Spain

IntroductionThe intentional use of drugs before or during sexual intercourse (chemsex) is a phenomenon of special importance in the MSM (men who have sex with men) population due to its impact on mental, physical and sexual health. Group therapy has been included in several programs for chemsex users.ObjectivesTo describe and to compare the different group therapy treatments for problematic chemsex users in NGOs community treatment settings in Spain.MethodsWe conducted several interviews with key informants from 5 NGO in Spain. A qualitative analysis of the different group therapy treatments for problematic chemsex was performed.Results Different models of groups were described including: psychoeducational, support, interpersonal process, harm reduction and mindfulness-based cognitive groups. Most of the group interventions developed were support and psychoeducational based. There were fewer interpersonal group and relapse prevention group therapy. The different models of group intervention were considered useful and necessary for deliver information in a culturally sensitive context and for reducing drug use, social isolation and loneliness.Conclusions Chemsex is a phenomenon that needs a multidisciplinary approach, including individual and group therapy. Group therapy for problematic chemsex has several advantages over individual model treatments, including the reduction of sense of isolation, loneliness, information and feedback from peers. More research is needed to analyze the implementation and efficacy of group therapy for chemsex users in different contexts.Disclosure of InterestNone Declared

Efficacy of low-dose rituximab in minimal change disease and prevention of relapse

BackgroundMinimal change disease (MCD) is a major cause of nephrotic syndrome (NS) in children and a minority of adults. The higher tendency to relapse put patients at risk for prolonged exposure to steroids and other immunosuppressive agents. B cell depletion with rituximab (RTX) may be beneficial to the treatment and prevention of frequently relapsing MCD. Therefore, this study aimed to verify the therapeutic/preventive effects of low-dose RTX on the relapse in adult with MCD.MethodsA total of 33 adult patients were selected for the study, including 22 patients with relapsing MCD in relapse treatment group who were treated with low-dose RTX (200 mg per week × 4 following by 200 mg every 6 months) and 11 patients in relapse prevention group with complete remission (CR) after steroid therapy were treated with RTX (200 mg ×1 every 6 months) for preventing the relapse of MCD.ResultsOf the 22 patients with MCD in relapse treatment group, there were 21 cases (95.45%) of remission [2 (9.09%) partial remission (PR), 19 (86.36%) CR], 1 (4.56%) no remission (NR) and 20 (90.90%) relapse-free. The Median duration of sustained remission was 16.3 months (3, 23.5 months, inter quartile range (IQR)). 11 patients in the relapse prevention group during a follow-up of 12 months (9–31 months) had no relapse. The average dose of prednisone in two groups after RTX treatment was significantly lower than before treatment.ConclusionThe results of this study suggested low-dose RTX can significantly reduce relapse rate and steroid dose in adults with MCD with fewer side effects. Low-dose RTX regimens may be beneficial for the treatment of relapsing MCD in adults and may be the preferred regimen for patients at high risk for the development of adverse events from corticosteroids.

Bupropion Slow Release vs Placebo With Adaptive Incentives for Cocaine Use Disorder in Persons Receiving Methadone for Opioid Use Disorder

Opioid-stimulant co-use is a common problem with few evidence-based treatments. To examine bupropion slow release (SR) enhancement of a tailored abstinence incentive program for stimulant use in persons with opioid use disorder. This 26-week, double-blind, placebo-controlled randomized clinical trial with a 4-week follow-up period was conducted at 4 methadone treatment programs in Baltimore, Maryland. Included participants were persons receiving methadone for the treatment of opioid use disorder with past 3-month cocaine use and current cocaine use disorder between March 2015 and September 2019. Data were analyzed from November 2020 through August 2022. A 6-week incentive induction period with monetary incentives for evidence of cocaine abstinence during thrice-weekly urine testing was conducted. Persons achieving 2 weeks of consecutive abstinence during induction were assigned to the relapse prevention group (20 individuals); otherwise, individuals were assigned to the abstinence initiation group (60 individuals). Participants were randomized within incentive groups to bupropion SR (150 mg oral twice daily; 40 participants) or placebo (40 participants). Incentives were available until week 26, and study medication ended week 30. The mean percentage of participants with cocaine abstinence (by negative urinalysis or self-report) during weeks 7 to 26 (ie, the incentive intervention period) and 27 to 30 (ie, the follow-up period) and the percentage of participants testing negative for cocaine at weeks 26 and 30 were assessed. Main effects of medication collapsed across incentive conditions and sensitivity analyses of medications within incentive conditions were assessed. Analyses were conducted in the modified intention-to-treat sample (ie, 80 individuals who received ≥1 dose of study medication) and completers (ie, 52 individuals who completed ≥1 visit during week 30). Among 80 participants (42 Black [52.5% ] and 35 White [43.8%]; mean [SD] age, 45.7 (9.4) years; 52 males [65.0%]) receiving methadone for opioid use disorder, 40 participants were randomized to receive bupropion SR and 40 participants to receive placebo. No significant difference on urinalysis or self-reported cocaine use was observed between medication groups. Sensitivity analyses revealed differential patterns for incentive subgroups. Participants in the relapse prevention group had high abstinence (>80%; eg, during weeks 7-26 in the modified intention-to-treat analysis, 410 of 456 samples [89.9%] from participants in the bupropion SR group tested negative for cocaine) throughout the trial regardless of whether they were randomized to bupropion SR or placebo. Participants in the abstinence initiation group had better outcomes with bupropion SR than placebo throughout the trial (mean [SD] total number of samples testing negative for cocaine, 30.3 [21.6] samples for bupropion SR vs 17.1 [14.9] samples for placebo; P = .05) and more participants receiving bupropion SR than placebo were abstinent at the end of the study (20 of 30 participants [66.7%] vs 9 of 30 participants [30.0%]; P = .04). In this randomized clinical trial, an overall benefit for bupropion SR vs placebo when combined with a financial abstinence incentive program was not observed. Results among incentive subgroups suggest that continued evaluation of medications, including bupropion SR, for stimulant treatment using a tailored approach that factors early abstinence into study design and interpretation may be needed. ClinicalTrials.gov Identifier: NCT02111798.

Self-interpellation in narratives about craving: Multiple and unitary selves.

The concept of addiction seeks to explain why people act contrary to their own best interest. At the centre stage of addiction discourse is craving, conceptualised as a strong urge to use substances. This article analyses how talk therapies such as relapse prevention and self-help groups shape identity constructions and understandings of craving among clients. Drawing upon interviews with individuals who have engaged in talk therapies in Sweden, we analyse how craving is made up through 'self-interpellation', that is, personal narratives about past, present or future thoughts, feelings and actions. The main 'self-interpellation' included multiple selves, where craving was elided by the true self and only felt by the inauthentic self. Less dominant were narratives which drew on a unitary self that remained stable over time and had to fight craving. The notion of multiple selves appeared as a master narrative that the participants were positioned by in their identity constructions. We conclude that this multiplicity seems ontologically demanding for people who try to recover from substance use problems. A demystification of craving, in which neither substance effects nor malfunctioning brains are blamed for seemingly irrational thoughts and actions, may reduce the stigmatisation of those who have developed habitual substance use.

A 12-session relapse prevention program vs psychoeducation in the treatment of Japanese alcoholic patients: A randomized controlled trial.

AimAlcoholism is the most prevalent substance use disorder in Japan; the estimated number of patients and high‐risk drinkers is in the millions. Although studies in the West have shown that cognitive behavioral therapy (CBT) is one of the most effective treatment strategies for alcoholic patients, there is a dearth of efficacy studies of CBT‐based intervention for those patients in the non‐Western setting. The aim of this study is to investigate the efficacy of a 12‐session CBT‐based relapse prevention program for Japanese alcoholic patients.MethodsForty‐eight alcoholic patients (M = 36, F = 12) who were admitted to an addiction treatment unit were randomly allocated either to a 12‐session relapse prevention (RP) program (n = 24) or a 12‐session psychoeducation (PE) program (n = 24). Both treatment programs were conducted in a group format once a week for 12 weeks. Other aspects of inpatient treatment (group meetings, etc) were the same in both groups. Self‐rating scales, which measure behavioral and cognitive coping, coping response, self‐efficacy, and cognition of drinking, were administered at pretreatment, mid‐treatment, and posttreatment periods. The proportion of participants who relapsed at 3 and 6 months after discharge was evaluated.ResultsBoth RP and PE groups showed significant improvement in self‐efficacy and cognition of drinking at posttreatment. However, there were no significant differences in the self‐rating scales between both groups. In addition, there were no significant differences in relapse rate at 3 and 6 months after discharge between both groups.ConclusionsThe 12‐session CBT‐based relapse prevention program and the psychoeducation program may be equally efficacious for alcoholic patients. Several factors that influenced the results are discussed.

Effectiveness of Mindfulness-based Relapse Prevention Group Therapy and Treatment as Usual on Shame and Self-criticism in Individuals with Opioid Use Disorder: A Comparative Investigation

Background: Shame and self-criticism are two variables that refer to negative self-assessment. Such negative self-assessments cause unpleasant emotions, which are among the known factors involved in drug abuse and relapse. Objectives: This study aimed to compare mindfulness-based relapse prevention (MBRP) group therapy and treatment as usual (TAU) in terms of their effect on shame and self-criticism in individuals with opioid use disorder (OUD). Patients and Methods: The current quasi-experimental study with a pretest-posttest and follow-up design was conducted on 36 patients who met the diagnostic and statistical manual of mental disorders (DSM-5) criteria for OUD. The participants were randomly assigned to two groups. One group received a combination of MBRP group therapy and TAU, and the other group was treated only by TAU. The participants filled out the Other as Shamer Scale and the Forms of Self-Criticizing/Attacking and Self-Reassuring Scale in the pretest, posttest, and follow-up stages. The data were statistically analyzed using a mixed-design analysis of variance. Results: The results indicated that the mean score of shame significantly decreased in the follow-up compared to pretest and posttest. Moreover, the combination of MBRP group therapy and TAU was significantly more effective than TAU alone. The posttest and follow-up mean scores of the participants who received a combination of MBRP group therapy and TAU were significantly lower than those treated only with TAU. Conclusions: The study results showed that MBRP could be considered an effective therapeutic approach for reducing shame and self-criticism in individuals with OUD.

Office-Based Buprenorphine Treatment: Identifying Factors That Promote Retention in Opioid-Dependent Patients.

Opiate addiction is a serious global health issue that profoundly impacts the welfare of populations around the world. Opioid addiction affects an estimated 1.9 million individuals in the United States alone, stimulating a rise in treatment options such as medication-assisted treatment with buprenorphine. When combined with counseling and relapse prevention groups, medication-assisted treatment has proven to be an effective office-based opioid treatment for opiate dependence. Office-based opioid treatment has broadened access to treatment of opioid dependence, has decreased the risk for overdose, and is effective for reducing cravings and opioid use at proper dosing levels. However, treatment retention and relapse remain significant challenges. The purpose of this study was to identify characteristics predictive of retention in treatment time of opioid-dependent individuals receiving office-based buprenorphine treatment. The records of individuals enrolled in a public health office buprenorphine clinic (n = 350) were analyzed to determine retention time in treatment and whether retention time varied by selected individual variables. Participants in the study had a cumulative predicted retention time on buprenorphine of 65% at 30 days, 35% at 6 months, 25% at 12 months, and 18% at 18 months.

PTSD Symptom Clusters and Craving Differs by Primary Drug of Choice

Objective: Research has demonstrated a cyclical relationship between posttraumatic stress disorder (PTSD) and substance use disorder. Identifying factors that link PTSD symptom clusters and substance use disorder may illuminate mechanisms underlying the PTSD–substance use disorder relationship, better informing interventions that target this comorbidity. The current study of individuals enrolled in an outpatient aftercare chemical dependency program in King County, Washington, assessed whether overall PTSD symptoms and specific PTSD symptom clusters predicted craving depending on individuals identified primary drug of choice (DOC). Methods: Participants eligible for the parent study were at least 18 years of age, fluent in English, medically cleared from substance withdrawal, and able to participate in treatment sessions and agreed to random assignment. Random assignment to either a mindfulness-based relapse prevention group, a standard relapse prevention group, or a treatment as usual group was conducted on a computer randomization program. A secondary analysis of baseline data was employed in the current study to determine which of the PTSD symptom clusters (avoidance, hyperarousal, and intrusion) predicted substance craving. Results: Covarying for severity of dependence, results suggest that overall PTSD scores predicted craving in participants who identified alcohol, stimulants, and opiates as their primary DOC. Further, avoidance-related PTSD symptoms alone predicted a significant proportion of the variability in craving in stimulant users, and hyperarousal symptoms alone predicted a significant proportion of the variability in craving in alcohol users. No specific PTSD cluster significantly predicted a proportion of the variability in craving in marijuana or opiates users. Conclusions: Findings suggest that craving may play a role in maintaining the relationship between specific PTSD symptom clusters and substance use disorder, and the nature of this relationship may differ by primary DOC. The clinical trial on which this secondary analysis of data was conducted is registered as NCT01159535 at www.clinicaltrials.gov.The original trial from which data for this study was drawn was supported by the National Institutes of Health [NIH/NIDA 5 R01 DA025764-02].

Individual gender and group gender composition as predictors of differential benefit from mindfulness-based relapse prevention for substance use disorders.

Mindfulness-based relapse prevention (MBRP) is an effective group-based aftercare treatment for substance use disorders (SUDs), yet few studies have examined moderators of MBRP efficacy. This secondary data analysis evaluated individual gender and group gender composition (e.g., proportion of women relative to men in each therapy group) as treatment moderators of MBRP. The analysis sample included 186 individuals with SUDs randomized to MBRP or relapse prevention (RP) as an aftercare treatment. Outcomes included number of heavy drinking days and drug use days at the 12-month follow-up. There were no treatment moderation effects for models with heavy drinking days as the outcome (all ps > .05). Group gender composition, but not individual gender, moderated the effect of treatment condition on drug use days (p < .01). Individuals who received MBRP had significantly fewer drug use days at 12-months than those who received RP, but only among individuals in therapy groups comprising one-third or more women (p <0 .0001). Specifically, all women and men who received MBRP in groups with one-third or more women were abstinent from drugs at month 12, whereas those in RP groups with one-third or more women had an average of about eight drug use days at month 12 (corresponding to a large between-treatment condition effect size). Group-based MBRP may be more efficacious than group-based RP, particularly when women compose at least one-third of the therapy group. Further research is warranted on gender and group gender composition as moderators of MBRP.

Integrated Treatment of PTSD and Substance Use Disorders: The Mediating Role of PTSD Improvement in the Reduction of Depression.

Posttraumatic stress disorder (PTSD) represents one of the most common mental health disorders, particularly among veterans, and is associated with significant distress and impairment. This highly debilitating disorder is further complicated by common comorbid psychiatric disorders, such as substance use disorders (SUD). Individuals with PTSD and co-occurring SUD also commonly present with secondary symptoms, such as elevated depression. Little is known, however, about how these secondary symptoms are related to treatment outcome. The aim of the present study, therefore, was to examine (1) the effects of treatment of comorbid PTSD/SUD on depressive symptoms; and (2) whether this effect was mediated by changes in PTSD severity or changes in SUD severity. Participants were 81 U.S. military veterans (90.1% male) with PTSD and SUD enrolled in a randomized controlled trial examining the efficacy of an integrated, exposure-based treatment (Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure; n = 54) versus relapse prevention (n = 27). Results revealed significantly lower depressive symptoms at post-treatment in the COPE group, as compared to the relapse prevention group. Examination of the mechanisms associated with change in depression revealed that reduction in PTSD severity, but not substance use severity, mediated the association between the treatment group and post-treatment depression. The findings underscore the importance of treating PTSD symptoms in order to help reduce co-occurring symptoms of depression in individuals with PTSD/SUD. Clinical implications and avenues for future research are discussed.

Using expressive arts in relapse prevention of young psychotropic substance abusers in Hong Kong

Art therapy has been empirically assessed as an effective form of relapse prevention for substance abusers who are relatively treatment resistant, defensive and unexpressive. In Hong Kong, the use of expressive arts in substance abuse treatment and relapse prevention programs has become increasingly popular in both residential and community-based services. However, unlike in the West, no empirical research has yet been conducted to validate and assess the effectiveness of such therapy within a Hong Kong context. This study adopted a two-group pre- and post- with 6-month follow-up experimental design to examine the effectiveness of an art-based relapse prevention group compared with a cognitive–behavioral relapse prevention group for young psychotropic substance abusers in a community-based outpatient service. The study included both a quantitative questionnaire and qualitative in-depth interviews with each participant. With 6 members in each of the group, only the qualitative data were discussed. The qualitative data revealed that the art-based relapse prevention group was particularly effective for the male participants, who were less verbal and sociable or had a strong sense of inadequacy and guilt about their delinquent behavior. In the experience of the participants, ‘family’ was a double-edged sword in terms of their growth and development. They had no choice but the victims bearing the lack of guidance and sense of loneliness in family conflicts or divorces. However, at the same time, family care, love and support were the greatest motivating factors to keep them abstinent. Therefore, the integration of art- and family-based interventions in drug relapse prevention programs is highly recommended.

Comparing Mindfulness-Based Group Therapy With Treatment as Usual for Opioid Dependents

Background:: In response to high burden of opioid abuse in Iran, Ministry of Health has launched a large-scale opioid maintenance treatment program, delivered through a network of certified drug treatment centers. To promote opioid pharmacotherapies, there is an urgent need to develop and introduce evidence-based psychosocial interventions into the network. Patients and Methods:: This is a randomized clinical trial (RCT) to investigate feasibility and effectiveness of adding mindfulness-based group therapy to opioid pharmacotherapies as compared to opioid pharmacotherapies alone. The primary outcomes were treatment retention and percentage of weekly morphine, methamphetamine, and benzodiazepine negative tests. Discussion:: This is the first RCT that explores the effectiveness of mindfulness-based relapse prevention group therapy among opioid dependent clients in Iran. The feasibility of group therapy and comparison of outcomes in intervention and control groups should be discussed in the outcome article.

Are we doing enough to enhance attendance to aftercare? Service users’ evaluation of a group relapse prevention programme for alcohol dependence

Purpose – The purpose of this paper was to evaluate and improve the quality of the aftercare services we provide for alcohol dependence. This presentation discusses the patient satisfaction of the Relapse Prevention Group. Design/methodology/approach – This was a prospective service users' satisfaction survey of those who attended the relapse prevention group programme at the Community Drug and Alcohol Team for the first 11 months of programme implementation. Findings – In all, 33 out of 36 people participated in the evaluation. The overall results were positive for the whole programme and people felt that the programme helped them in their recovery. Originality/value – Monitoring of service users’ satisfaction with aftercare services could provide insight into the barriers compromising engagement.

Comparing Mindfulness-Based Group Therapy With Treatment as Usual for Opioid Dependents: A Pilot Randomized Clinical Trial Study Protocol.

Background:In response to high burden of opioid abuse in Iran, Ministry of Health has launched a large-scale opioid maintenance treatment program, delivered through a network of certified drug treatment centers. To promote opioid pharmacotherapies, there is an urgent need to develop and introduce evidence-based psychosocial interventions into the network.Patients and Methods:This is a randomized clinical trial (RCT) to investigate feasibility and effectiveness of adding mindfulness-based group therapy to opioid pharmacotherapies as compared to opioid pharmacotherapies alone. The primary outcomes were treatment retention and percentage of weekly morphine, methamphetamine, and benzodiazepine negative tests.Discussion:This is the first RCT that explores the effectiveness of mindfulness-based relapse prevention group therapy among opioid dependent clients in Iran. The feasibility of group therapy and comparison of outcomes in intervention and control groups should be discussed in the outcome article.

P286 Recommendations For Smoking Cessation Service Provision For Smokers With Copd With Multiple Complex Needs: Findings From A Pilot Study

Introduction Smokers with COPD are highly nicotine addicted and often have additional complex needs. Quit rates are poor and there is little evidence-based guidance on specific cessation interventions for these patients. This pilot study aimed to identify barriers to smoking cessation for this patient group. Method Smokers with COPD were offered up to 12 individual sessions with a clinical psychologist in addition to standard smoking cessation counselling and pharmacotherapy. The psychological intervention included an initial assessment and formulation on factors maintaining smoking which informed an individualised psychology intervention targeting barriers to smoking cessation. Results 57 patients (moderate COPD, high prevalence of complex physical andpsychological comorbidities) were included in the study (Table 1). 20/57 (35%) patients attended >2 sessions (mean=5, range 2–12). 7/20 had already quit (relapse prevention referrals), 13 were smokers. 22/57 (39%) patients never engaged, 15/57 (26%) were lost to follow-up. 6/7 (86%) of the relapse prevention group maintained their quit. 2/13 (15%) of the current smoker group maintained a 28 day quit and 4/13 (31%) reduced tobacco intake. Psychological barriers to quitting were identified including smoking as a means of emotion regulation. Conclusions For COPD smokers with a heavy smoking history and multiple quit attempts, and complex needs, additional psychological intervention alongside traditional quit smoking support may aid in preventing relapse, although further research is needed. For current smokers, the hypothesis was not supported, although the study did illuminate common themes regarding obstacles to quitting for this complex group who present a challenge to traditional quit smoking services. It is clear that the current ‘one size fits all’ approach to smoking cessation does not meet the needs of these smokers who require more focused specific interventions to support smoking cessation including: Pre-quit support ‘Cut down to quit’ approach Long-term, intensive follow up Assertive outreach Multi-agency working The above recommendations may provide a starting point for future service design.

Qualitative clinical evaluation of a pilot bipolar relapse prevention group intervention in an out-patient psychiatric setting

An 11 week pilot cognitive behavioural therapy (CBT)/psychoeducation relapse prevention group was set up for bipolar clients. Thematic analysis of qualitative feedback showed a decrease in relapses and an improvement in psychological well-being. This demonstrates that such psychological interventions, alongside pharmacological treatments, can be effective in relapse prevention.

Clinical Trial of an Innovative Dual-Processing Group Therapy Relapse Prevention Protocol Conducted in a Community-Based Setting

The purpose of this article is to describe an interdisciplinary clinical trial conducted in a community-based setting. The article will (a) present an overview of the current study, (b) detail an innovative outpatient relapse prevention group therapy practice model informed by the neuroscientific literature on addiction, (c) present case examples of patient response to treatment, and (d) provide qualitative data of patient feedback and preliminary functional magnetic resonance imaging data results.

The RoadMAP Relapse Prevention Group Counseling Toolkit™: counselor adherence and competence outcomes

Training counselors in empirically supported treatments (ESTs) far exceeds the ever decreasing resources of community-based treatment agencies. The purpose of this study was to examine outpatient substance abuse group counselors' (n=19) adherence and competence in communicating and utilizing concepts associated with empirically-supported relapse prevention treatment following a brief multimedia toolkit (RoadMAP Toolkit™) training. Moderate or large baseline to post-training effect sizes for counselor adherence to toolkit content were identified for 13 of 21 targeted behaviors (overall d range=.06–2.85) with the largest gains on items measuring active skill practice. Post-training adherence gains were largely maintained at the 6-month follow-up, although no statistically significant improvements were identified over time for counselor competence. This study provides important preliminary support for using a multi-media curriculum approach to increase empirically-supported relapse prevention skills among group counselors. Future research should focus on finding ways to improve counselor skill level and to determine the impact of the Toolkit on client outcomes.

An Open Trial of Relapse Prevention Therapy for Smokers With Schizophrenia

Objective: Following successful smoking cessation, smokers with schizophrenia are vulnerable to relapse shortly after treatment discontinuation. Our objective was to assess the feasibility and effectiveness of a 12-month relapse prevention intervention in recently abstinent smokers with schizophrenia. Method: Adult outpatient smokers with schizophrenia received weekly cognitive-behavioral therapy groups, bupropion slow-release, transdermal nicotine patch, and nicotine gum or lozenge for 3 months. Subjects with 7-day point prevalence abstinence at month 3 received an additional 12 months (months 4 through 15) of therapy with bupropion, transdermal nicotine patch, and nicotine gum/lozenge in conjunction with relapse prevention–based cognitive-behavioral therapy groups that were held weekly in month 4, biweekly in months 5 and 6, and monthly in months 7 through 15. Results: Seventeen of 41 participants (41.5%) attained biochemically verified self-report of 7-day point prevalence abstinence at the end of 3 months of treatment and entered relapse prevention treatment. There was an 81% attendance rate at relapse prevention groups. At the end of the 12-month relapse prevention phase (month 15 overall), 11 of 17 (64.7%) demonstrated biochemically verified 7-day point prevalence abstinence, and 10 of 17 (58.8%) reported 4-week continuous abstinence. Almost one-quarter of the sample (23.5%) demonstrated long-term prolonged abstinence through the end of the trial. There were no clinically detected cases of psychiatric symptom exacerbation. One participant, who was managed as an outpatient, self-reported psychiatric symptom exacerbation in the interim period between study visits. Conclusions: Extended-duration smoking cessation treatment is well tolerated and may improve smoking outcomes for recently abstinent smokers with schizophrenia. Controlled trials are warranted.