Relapse Prevention Methods Research Articles

Analysis of cell immune regulation features in recurrent ovarian endometriosis

BACKGROUND: The prevalence of endometriosis among women of reproductive age and the complexity of choosing the methods for its effective treatment necessitate the study of the clinical and morphological features of ovarian endometriosis in its recurrent course, as well as the search for available informative diagnostic and prognostic markers which allow identifying risk groups for relapse and form prevention methods. Endometriomas have a recurrence rate of 5055 % after treatment.
 AIM: The aim of this study was to conduct a comparative analysis of cell immune regulation features in recurrent ovarian endometriosis.
 MATERIALS AND METHODS: We studied clinical data, the value of peripheral immunocompetent blood cells, as well as morphological and immunohistochemical data of 196 patients operated on for endometrioid ovarian cysts, including 45 patients with a recurrent course of the disease and 151 women without relapse. Monoclonal mouse antibodies to T helpers (CD4), T killers (CD8), B lymphocytes (CD20), and macrophages (CD68) were used for immunohistochemical examination of the surgical material. Immunological examination of peripheral blood was performed by flow cytometry with the assessment of helper T lymphocyte, killer T lymphocyte and B lymphocyte subpopulations and their ratios.
 RESULTS: The recurrence rate of endometrioid ovarian cysts was 22.96%. Most patients (48.87%) relapsed 34 years after the first operation. In patients with recurrent endometrioma, we more often detected complaints of dyspareunia, dysmenorrhea, primary infertility and a history of operations on the uterine appendages unrelated to endometriosis in anamnesis, as well as the third degree of the pathological process. During morphological examination, the glandular-cystic variant and morphologically active lesions were detected more often in recurrent endometriosis compared to the relapse-free course. Cytotoxic T killers (CD8) and macrophages (CD68) were shown to be the predominant subpopulation of cells found in the inflammatory infiltrate of cytogenic stroma and endometrioid cyst capsule. More of them were detected in recurrent endometrioid cysts in the surgical material of both the first and second operations compared to the relapse-free course. B lymphocyte count was significantly higher in the cyst capsule with recurrent endometriosis than in cases of the relapse-free course. T helpers (CD4) were found only in the surgical material of an already diagnosed recurrence. Immunological examination of peripheral blood of patients with recurrent endometrioma revealed an increase in the total population of T lymphocytes due to a subpopulation of T helpers, the number of which per microliter exceeded the reference values.
 CONCLUSIONS: An increase in the number of free stromal cells in the foci of endometriosis with its recurrent course indicates the importance of hyperreactivity and the autoimmune mechanism in the chronization and progression of the disease.

The effectiveness of the narrative therapy on the fear of negative/positive evaluation and social phobia symptoms in socially anxious female students

Introduction: Schizophrenia is one of the most severe mental disorders. It is characterized by a chronic course, diverse clinical image, and it often leads to incapacity. The course and severity of the disease may vary, while the appearing symptoms constitute a turning point in patient’s and his family’s life. This is why it is important to recognise the symptoms and undertake therapeutic measures. The reoccurrence of the disease does not appear suddenly. Usually it is preceded by the period of various changes in patient’s behaviour and feelings. Those changes are called the warning signs of a relapse. The aim of this research was to learn about patients’ knowledge of schizophrenia, the consequences of not following the doctor’s orders and the warning signs of a relapse. Material and methods: The study group consisted of 69 patients from Mental Health Clinic in Bielsko-Biala. For the purpose of this MA thesis the method of diagnostic survey was used. The survey included authorial questionnaire consisting of 30 structured questions with the possibility of giving one or more answers. Results and conclusions: In the course of the conducted research obtained the results which indicated the high level of studied patients’ knowledge of schizophrenia, its symptoms and the warning signs of a relapse as well as ways of treatment. The examined people expressed the awareness that following doctor’s orders may significantly decrease the risk of relapse. The most relevant issue concerning the acceptance of a disease, the level of patients’ awareness of a disease and systematic compliance with the recommendations of medical staff were enumerated. Most respondents experienced a relapse, despite their declared knowledge of relapse prevention methods. Side effects of used medicines were the frequent cause of treatment discontinuation. The patients indicated contact with medical staff as the main source of broadening their knowledge.

Wiedza pacjentów ze schizofrenią dotycząca rozpoznania objawów zwiastujących nawrót choroby

Introduction: Schizophrenia is one of the most severe mental disorders. It is characterized by a chronic course, diverse clinical image, and it often leads to incapacity. The course and severity of the disease may vary, while the appearing symptoms constitute a turning point in patient’s and his family’s life. This is why it is important to recognise the symptoms and undertake therapeutic measures. The reoccurrence of the disease does not appear suddenly. Usually it is preceded by the period of various changes in patient’s behaviour and feelings. Those changes are called the warning signs of a relapse. The aim of this research was to learn about patients’ knowledge of schizophrenia, the consequences of not following the doctor’s orders and the warning signs of a relapse. Material and methods: The study group consisted of 69 patients from Mental Health Clinic in Bielsko-Biala. For the purpose of this MA thesis the method of diagnostic survey was used. The survey included authorial questionnaire consisting of 30 structured questions with the possibility of giving one or more answers. Results and conclusions: In the course of the conducted research obtained the results which indicated the high level of studied patients’ knowledge of schizophrenia, its symptoms and the warning signs of a relapse as well as ways of treatment. The examined people expressed the awareness that following doctor’s orders may significantly decrease the risk of relapse. The most relevant issue concerning the acceptance of a disease, the level of patients’ awareness of a disease and systematic compliance with the recommendations of medical staff were enumerated. Most respondents experienced a relapse, despite their declared knowledge of relapse prevention methods. Side effects of used medicines were the frequent cause of treatment discontinuation. The patients indicated contact with medical staff as the main source of broadening their knowledge.

Preventing relapse with personalized smart-messaging after cognitive behavioural therapy: A proof-of-concept evaluation.

ObjectivesCognitive behavioural therapy (CBT) can improve symptoms of anxiety and depression, but also reduces the risk of future relapse after therapy completion. However, current CBT relapse prevention methods are resource‐intensive and can be limited in clinical practice. This paper investigates a personalized means of reducing relapse using smart‐messaging in two settings: research and routine care.DesignStudy 1 presents a cohort study comparing a cohort of smart‐messaging users versus non‐users. Study 2 presents time series follow‐up data from a case series of smart‐messaging users from clinical practice.MethodsFifteen of 56 CBT completers who participated in a trial for the treatment of health anxiety wrote advice they would want if in future they were doing well, experiencing early warning signs of relapse, or experiencing full relapse. Following CBT, participants received weekly text‐message requests to rate their well‐being. Dependent upon their response, participants received tailored advice they had written, appropriate to the well‐being level reported after recovery from health anxiety. Smart‐messaging was also trialled in a routine practice sample of 14 CBT completers with anxiety and depression.ResultsAcross a 12‐month follow‐up, participants receiving smart‐messaging showed greater health improvements than those who did not. Well‐being scores showed stability between CBT completion and 6‐month follow‐up among routine care patients.ConclusionsThese findings suggest that a low‐intensity, personalized relapse prevention method can have a clinical benefit following CBT for common mental health problems.Practitioner points Post‐treatment outcomes may be improved using personalized smart‐messaging to prevent relapse following cognitive behavioural therapy (CBT) for health anxiety.In clinical practice, post‐treatment smart‐messaging can be well‐used by patients and may help maintain stable well‐being in the 6 months after CBT ends.This evidence supports the clinical utility of a brief tailored digital intervention, which can be integrated within routine clinical practice with minimal therapist input.Overall, longer‐term post‐CBT outcomes may be improved by integrating a smart‐messaging intervention at the end of therapy.

An expert consensus on the most effective components of cognitive behavioural therapy for adults with depression: a modified Delphi study

ABSTRACTDesigning new approaches to delivering cognitive behavioural therapy (CBT) requires an understanding of the key components. This study aimed to establish an expert consensus on the effective components of CBT for depressed adults. An international panel of 120 CBT experts was invited to participate in a modified Delphi study. Thirty-two experts participated in round 1; 21 also provided data in round 2. In round 1, experts rated the effectiveness of 35 content and process components. A priori rules identified components carried forward to round 2, in which experts re-rated items and final consensus items were identified. Consensus was achieved for nine content components (ensuring understanding; developing and maintaining a good therapeutic alliance; explaining the rationale for CBT; eliciting feedback; identifying and challenging avoidant behaviour; activity monitoring; undertaking an initial assessment; relapse prevention methods; homework assignments); and three process components (ensuring therapist competence; scheduling sessions flexibly; scheduling sessions for 45–60 mins). Five of the twelve components identified were generic therapeutic competences rather than specific CBT items. There was less agreement about the effectiveness of cognitive components of CBT. This is an important first step in the development of novel approaches to delivering CBT that may increase access to treatment for patients.

The Effects of Family-Centered Problem-Solving Education on Relapse Rate, Self Efficacy and Self Esteem Among Substance Abusers.

Background:The success of drug abuse treatment and relapse prevention methods depends widely on not only pharmaceutical and non-pharmaceutical therapies but also self efficacy and self esteem promotion.Objectives:The current study attempted to clarify the effects of Problem Solving Education (PSE) on relapse rate, self efficacy and self esteem among drug abusers.Patients and Methods:This non-controlled clinical trial (quasi-experimental) assessed 60 opium and heroin abusers who were willing to quit and were referred to the Mehr Center of Addiction Treatment and Rehabilitation Facility. The patients were allocated to two groups of 30 (intervention and control groups). While both groups received the routine care of the clinic, the intervention group also attended eight 45-minute family-centered PSE sessions. The Coopersmith Self esteem Inventory and Quit Addiction Self efficacy Questionnaire were filled out for all subjects before and after the intervention. Drug relapse was investigated four times with two-week intervals. The two groups were compared using chi-square and Student’s-t tests. Logistic regression analysis was applied to determine factors affecting drug relapse.Results:A total of 45 individuals (21 and 24 in the intervention and control groups, respectively) completed the study. At baseline, the two groups had no significant difference regarding their mean scores of self esteem and self efficacy (P = 0.692 and 0.329, respectively). After the intervention, however, the mean changes of self esteem scores were 20.10 ± 3.75 for the intervention group and 4.50 for the control group (P < 0.001). The mean changes of self efficacy scores in the mentioned groups were 34 34.17 ± 5.19 and 9.03± 2.04, respectively (P < 0.001). Drug relapse after two weeks was correlated with age (OR = 1.216; P = 0.026; 95% CI: 1.024-1.445) and implementation of the intervention (OR = 0.036; P = 0.003; 95% CI: 0.004-0.322).Conclusions:According to our findings, supplementing drug abuse treatment with cognitive behavior therapy, particularly PSE, can reduce relapse rate and enhance self efficacy and self esteem among patients.

Relapse prevention interventions for smoking cessation

A number of treatments can help smokers make a successful quit attempt, but many initially successful quitters relapse over time. Several interventions have been proposed to help prevent relapse. To assess whether specific interventions for relapse prevention reduce the proportion of recent quitters who return to smoking. We searched the Cochrane Tobacco Addiction Group trials register in May 2013 for studies mentioning relapse prevention or maintenance in title, abstracts or keywords. Randomized or quasi-randomized controlled trials of relapse prevention interventions with a minimum follow-up of six months. We included smokers who quit on their own, were undergoing enforced abstinence, or were participating in treatment programmes. We included trials that compared relapse prevention interventions with a no intervention control, or that compared a cessation programme with additional relapse prevention components with a cessation programme alone. Studies were screened and data extracted by one review author, and checked by a second. Disagreements were resolved by discussion or by referral to a third review author. Sixty-three studies met inclusion criteria but were heterogeneous in terms of populations and interventions. We considered 41 studies that randomly assigned abstainers separately from studies that randomly assigned participants before their quit date.Upon looking at studies of behavioural interventions that randomly assigned abstainers, we detected no benefit of brief and 'skills-based' relapse prevention methods for women who had quit smoking because of pregnancy, or for smokers undergoing a period of enforced abstinence during hospitalisation or military training. We also failed to detect significant effects of behavioural interventions in trials in unselected groups of smokers who had quit on their own or through a formal programme. Amongst trials randomly assigning smokers before their quit date and evaluating the effects of additional relapse prevention components, we found no evidence of benefit of behavioural interventions or combined behavioural and pharmacotherapeutic interventions in any subgroup. Overall, providing training in skills thought to be needed for relapse avoidance did not reduce relapse, but most studies did not use experimental designs best suited to the task and had limited power to detect expected small differences between interventions. For pharmacological interventions, extended treatment with varenicline significantly reduced relapse in one trial (risk ratio (RR) 1.18, 95% confidence interval (CI) 1.03 to 1.36). Pooling of six studies of extended treatment with bupropion failed to detect a significant effect (RR 1.15, 95% CI 0.98 to 1.35). Two small trials of oral nicotine replacement treatment (NRT) failed to detect an effect, but treatment compliance was low, and in two other trials of oral NRT in which short-term abstainers were randomly assigned, a significant effect of intervention was noted. At the moment, there is insufficient evidence to support the use of any specific behavioural intervention to help smokers who have successfully quit for a short time to avoid relapse. The verdict is strongest for interventions focused on identifying and resolving tempting situations, as most studies were concerned with these. Little research is available regarding other behavioural approaches.Extended treatment with varenicline may prevent relapse. Extended treatment with bupropion is unlikely to have a clinically important effect. Studies of extended treatment with nicotine replacement are needed.

Nonmyeloablative Allogeneic Stem Cell Transplantation for Non-Hodgkin Lymphoma

Non-Hodgkin lymphomas constitute a heterogeneous group of hematologic malignancies with varying aggressiveness and many therapeutic options. Nonmyeloablative (NMA) conditioning has been the cornerstone of allogeneic adoptive immunotherapy for these diseases. This approach utilizes a reduced intensity preparative regimen to achieve engraftment with little toxicity. This allows for development of the immune graft-versus-lymphoma effect. Results depend on the histologic type of lymphoma, prognostic factors, patient characteristics, and chemosensitivity. For follicular lymphomas, NMA transplants are highly effective in patients with refractory or recurrent disease after the best chemoimmunotherapy available and who have a matched sibling or unrelated donor. In mantle cell lymphoma, autologous stem cell transplants are generally ineffective for patients with recurrent disease; we reported 6-year actuarial progression-free survival rate of 46%, using NMA allogeneic transplants. The indications of NMA transplants for diffuse large B-cell lymphoma and T-cell lymphomas are controversial; success has been reported in selected high-risk patients and those relapsing after an autologous transplantation who have chemosensitive disease. Considerations for the conditioning regimen, donor source, graft-versus-host disease prophylaxis, donor lymphocyte infusion, and relapse prevention methods are reviewed.

Psychosocial Factors Related to Gambling Abstinence and Relapse in Members of Gamblers Anonymous

Problem gamblers account for almost one-third of the industry's total revenue with the adverse effects of problem gambling including significant financial loss, legal and occupational difficulties, family problems, psychological distress and suicide. As such, it is important to understand the influential factors in gambling abstinence and relapse, which will assist in the development of relapse prevention methods in therapeutic treatment regimes. This paper reported the role of a set of seven predictors in distinguishing between abstinent and relapsed gamblers among 75 Gambling Anonymous (GA) members (55 males; 20 females; Mean age 45 years) in Southeast Queensland. The measures taken were meeting Attendance and Participation, Social Support, God Belief, Belief in a Higher Power, Working the 12-steps of Recovery, Gambling Urges and Erroneous Cognitions. Discriminant analysis revealed that the variables separating the two groups were significant, suggesting that GA members achieving abstinence could be distinguished from those who relapsed, with Attendance and Participation, and Social Support contributing the greatest influence on member's ability to abstain from gambling. The findings suggested that GA member's involvement in meetings, and support from family and friends had significant impact on their gambling abstinence. In contrast, increased gambling urges and erroneous cognitions increased the chance of relapse.

SMOKING CESSATION IN PREGNANT WOMEN

Cigarette smoking is considered the most significant modifiable cause of adverse pregnancy outcomes in US women. Smoking cessation in pregnant patients is one of the most effective ways to reduce negative pregnancy outcomes of fetal growth retardation, preterm delivery, and perinatal mortality. Research evidence documenting the effectiveness of health care provider interventions in smoking cessation has led to the PHS recommendation to screen and counsel every patient. Materials from the PHS and NCI are available to assist health care providers in developing a brief office-based intervention. Patient materials for distribution are also available. Increased use of office-based cessation strategies, of cessation programs in community-based interventions, and of pharmacologic therapies is necessary to remedy the public health burden of fetal exposure to tobacco. Relapse prevention methods using office-based and social support systems are important to improve long-term maintenance of cessation in women who quit smoking during pregnancy.

A maintenance program for obsessive-compulsive disorder using exposure with response prevention: 2-year follow-up

Recent literature has emphasized the importance of instituting procedures for preventing relapse in obsessive-compulsive disorder (OCD). This study presents data documenting the effect of a maintenance program on the long term (2-year) adjustment of a group of patients with OCD treated with exposure and response prevention. Results indicate that patients maintained their gains for the 2-year follow-up period on measures of anxiety associated with avoidance (Behavioral Avoidance Test), obsessions, compulsions, and anxiety. Further, patients were able to effectively manage situations defined as lapses (limited symptom return) effectively without additional therapist intervention. However, as in a previous report, treatment gains for depression were not well established. It is concluded that sessions prior to treatment termination which focus on relapse prevention methods focus on additional psychological symptoms aside from the acute disturbance of OCD.

Relapse Prevention: Overview of Research Findings in the Treatment of Problem Drinking, Smoking, Obesity and Depression

The aim of this paper is to provide an overview of developments in the area of relapse prevention for selected psychological disorders: problem drinking; smoking; obesity; and depression. Relapse prevention methods, including booster sessions, have been associated with mixed outcomes, although there are some encouraging findings, particularly in the treatment of obesity and alcohol problems. A number of recommendations are made for research and/or clinical practice. In the treatment of alcohol problems it is recommended that more attention be paid to reducing co-existent marital problems and mood disorders. In obesity, there is a need for evaluations of intensive, long-term therapist contact with the severely obese, particularly those with serious medical problems. Studies of the complete relapse prevention approach advocated by Marlatt and Gordon (1985) are needed in the evaluation of smoking cessation programmes. It is concluded that maintenance of gains in smoking, obesity and problem drinking comes at a considerable cost in time and therapist contact. To date, there has been little application of relapse prevention methods to depression, and further empirical work is needed to identify the determinants of relapse and the efficacy of specific maintenance-enhancement strategies. Consistent themes in the prediction of relapse are identified, including low social support, ongoing interpersonal difficulties, and low self-efficacy.

Psychological Approaches for the Treatment of Cocaine Dependence-A Neurobehavioral Approach

A variety of psychological approaches have been utilized for the treatment of cocaine dependence. Most information has been presented in case report format. However, several investigations have established integrated outpatient approaches which are currently being systematically evaluated. One of these approaches, the neurobehavioral model of cocaine dependency treatment establishes a clear timetable for cocaine recovery and focusses attention on four discreet areas of functioning. Strategies for addressing these areas of functioning include relapse prevention methods as well as individual therapy procedures, family systems materials, educational information, 12 step involvement and urine testing. The model constructs a comprehensive framework for facilitating involvement in recovery activities which promote positive behavior change. Use of this standardized treatment format allows for the evaluation of the treatment model. In an open trial with 486 cocaine users, a majority of subjects were retained in treatment for a clinically significant period of time and while in treatment provided urine samples indicating substantial periods of cocaine abstinence. Current research is underway to evaluate: (1) subject factors which appear to be related to successful outcome with this treatment model; (2) a controlled clinical trial to evaluate the treatment model with cocaine users using random assignment; (3) a double-blind evaluation of desipramine versus placebo and versus no medication as an adjunct to the support provided by the model.

Preventing relapse in the treatment of nicotine addiction: current issues and future directions.

Although smoking-cessation rates have continued to increase, the vast majority of smokers who quit eventually relapse. Between 1974 and 1985, over 1.3 million smokers quit during each of those years. However, 75% to 80% of those individuals resumed smoking within six months. This article describes the dynamic phenomenon of smoking relapse within the context of cyclical episodes of smoking and quitting during an individual's lifetime. Theories of the determinants of smoking relapse are reviewed and methods designed to prevent relapse are described. Smoking relapse is discussed in terms of three aspects of tobacco addiction: (1) biological-addiction mechanisms, (2) conditioning processes, and (3) cognitive-social learning factors. The major determinants of smoking relapse are reviewed, including nicotine withdrawal, stress, weight gain, social influences, conditioning factors, causal attributions, and environmental variables. A transtheoretical-developmental model is explored in the longitudinal investigation of the natural history of slips (lapses) and relapse episodes. Relapse prevention interventions are described that emphasize self-awareness, self-regulation, self-efficacy, affect regulation, social support, and lifestyle balance. Recent developments in pharmacological adjuncts to treatment are also examined. It is concluded that innovative relapse prevention methods need to be designed for hard-core smokers with histories of cessation failures, substance abuse and/or psychiatric impairment. These and other recommendations for future research on smoking relapse and relapse prevention are discussed.

Smoking-Cessation Treatment Combining Transdermal Nicotine Substitution with Behavioral Therapy

Effects of smoking-cessation treatment combining transdermal nicotine substitution with behavioral therapy were investigated in two studies. A total of 403 smokers underwent nine weeks of behavioral self-control treatment. For seven weeks, groups with transdermal nicotine substitution were also provided with nicotine patches that continuously release nicotine through the skin into the circulatory system. The effects of treatment were measured by total abstinence. The results showed that the nicotine concentration in the patch, special relapse prevention methods, and the type of dosage (individual versus fixed dose) had no influence on therapeutic success. Nicotine concentration played a decisive role in the compatibility of the patch. Combining transdermal nicotine substitution with behavioral therapy produced 12-month success rates (total abstinence) of about 35%.

Alcoholics Anonymous-Narcotics Anonymous model inpatient treatment of chemically dependent adolescents: a 2-year outcome study.

Many hospital and residential chemical dependency treatment facilities utilize Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) principles and practices in therapeutic programming. Although well-known and broadly endorsed and supported, such AA/NA approaches have received little research attention especially in regard to chemically dependent adolescents. The present study examined chemical usage and social-civil-productive functioning in 157 male and female chemically dependent adolescents at 6, 12 and 24 months after leaving an AA/NA-based treatment program. Results revealed that both treatment completers and noncompleters (those who left treatment prematurely against professional/medical advice) demonstrated less chemical use after their respective hospitalizations than before. Although significantly higher percentages of both male and female treatment completers were found abstinent/essentially abstinent at 6 months post discharge in contrast to noncompleters, abstinence rates, particularly for male subjects, declined sharply by 1 and 2 years after treatment. Results indicated that the AA/NA model is a promising approach in treating chemically dependent adolescents, but that much attention to relapse prevention methods is necessary.

Towards a Rehabilitation of Methadone Maintenance: Integration of Relapse Prevention and Aftercare

Methadone maintenance was originally proposed as a long-term treatment modality for opiate addiction. However, most clients leave methadone maintenance rather than take methadone indefinitely and subsequently relapse to opiate use. In this article, the author examines relapse to opiate use by clients during and after methadone maintenance treatment in the United States. He reviews models of relapse prevention and aftercare which may be applicable to clients in methadone treatment. There now exist structured and psychotherapeutic relapse prevention methods which may be integrated into methadone maintenance treatment and could serve, in addition, to revitalize methadone maintenance treatment.

Preventing Relapse in the Treatment of Nicotine Addiction: Current Issues and Future Directions

Although smoking-cessation rates have continued to increase, the vast majority of smokers who quit eventually relapse. Between 1974 and 1985, over 1.3 million smokers quit during each of those years. However, 75% to 80% of those individuals resumed smoking within six months. This article describes the dynamic phenomenon of smoking relapse within the context of cyclical episodes of smoking and quitting during an individual's lifetime. Theories of the determinants of smoking relapse are reviewed and methods designed to prevent relapse are described. Smoking relapse is discussed in terms of three aspects of tobacco addiction: (1) biological-addiction mechanisms, (2) conditioning processes, and (3) cognitive-social learning factors. The major determinants of smoking relapse are reviewed, including nicotine withdrawal, stress, weight gain, social influences, conditioning factors, causal attributions, and environmental variables. A trans-theoretical-developmental model is explored in the longitudinal investigation of the natural history of slips (lapses) and relapse episodes. Relapse prevention interventions are described that emphasize self-awareness, self-regulation, self-efficacy, affect regulation, social support, and lifestyle balance. Recent developments in pharmacological adjuncts to treatment are also examined. It is concluded that innovative relapse prevention methods need to be designed for hard-core smokers with histories of cessation failures, substance abuse and/or psychiatric impairment. These and other recommendations for future research on smoking relapse and relapse prevention are discussed.

Neurobehavioral Treatment for Cocaine Dependency

Relapse prevention techniques have recently been incorporated into some nonpharmacologic models of chemical dependency treatment. The neurobehavioral model of cocaine dependency treatment establishes a clear timetable for recovery from cocaine dependency and focuses on four distinct areas of functioning. Strategies for addressing these areas of functioning include the use of relapse prevention methods and individual therapy procedures, family systems materials, 12-Step involvement, and urine testing. The model constructs a comprehensive framework for facilitating involvement in recovery activities that promote positive behavior change. The relapse prevention group component of the model is described, the use of a systematic relapse analysis procedure is presented, and an outline of plans for evaluating the model is discussed. The development of a comprehensive outpatient treatment model for treating cocaine dependency provides a standardized structure within which other treatment interventions (e.g., medication, acupuncture) could be evaluated.

Epidemic cocaine abuse: America's present, Britain's future?

SummaryEpidemic cocaine abuse has become a major problem in America and may be spreading to England. The paper reviews the historical setting in which cocaine first became a problem in America at the turn of the century and its recent re‐emergence. Possible reasons for this are explained including myths as to its safety, relationship to prior marijuana use, celebrity endorsements and the role of the media, changes in the route of administration and the reinforcing effects of the drug itself. Since heavy cocaine use is now understood to cause a physiologic as well as a psychologic dependence, treatment may need to deal with neurochemical changes possibly involved in the persistent relapses. Pharmacologic approaches to remedy this, especially use of certain tricyclics, are discussed as are a variety of psychological treatments including behavioral, supportive and relapse prevention methods. The paper concludes by listing possible interventions that might lessen the problem if adopted including steps that can be taken in the realms of education, law enforcement, and treatment.