Lowering HIV risk among ethnic minority drug users: comparing culturally targeted intervention to a standard intervention.

To test the efficacy of culturally targeted acquired immunodeficiency syndrome (AIDS) prevention programs on ethnic minority street drug users, 669 African-American and Puerto Rican drug users were assigned to receive either the National Institute on Drug Abuse (NIDA) standard intervention or a culturally competent enhanced intervention in a quasi-experimental study. The standard intervention was a two-session educational program, while both the African-American and Puerto Rican enhanced interventions provided additional AIDS information in a culturally appropriate fashion. Although human immunodeficiency virus (HIV) risk behaviors, as measured by Bell's risk indices, decreased, there were no meaningful significant differences between interventions. However, participants who went into drug treatment programs showed greater reduction in HIV risk behavior. Cultural interventions may provide better outcome if they concentrate on getting participants into drug treatment.

Employment outcomes in family-aided assertive community treatment.

Family-aided assertive community treatment (FACT) was enhanced by adding vocational specialists to help persons with severe mental illness obtain competitive employment. Results were then tested against those of conventional vocational rehabilitation (CVR). The FACT cohort demonstrated significantly better employment rates than did the CVR, while negative symptoms declined in the former and increased in the latter. No evidence was found that competitive work presented a significant risk for relapse.

Variation in drug injection frequency among out-of-treatment drug users in a national sample.

This article analyzes data on drug injection frequency in a sample of more than 13,000 out-of-treatment drug injectors interviewed across 21 U.S. cities and Puerto Rico through the National Institute on Drug Abuse (NIDA) Cooperative Agreement for AIDS Community-Based Outreach/Intervention Research Program. The goals of the article are to present findings on injection frequency and to predict variation in terms of a set of variables suggested by previous research, including location, ethnicity, gender, age, educational attainment, years since first use of alcohol and marijuana, income, living arrangement, homelessness, drugs injected, and duration of injection across drugs. Three models were tested. Significant intersite differences were identified in injection frequency, although most of the other predictor variables we tested accounted for little of the variance. Ethnicity and drugs injected, however, were found to be significant. Taken together, location, ethnicity, and type of drug injected provide a configuration that differentiated and (for the variables available for the analysis) best predicted injection frequency. The public health implications of these findings are presented.

A comparison of two levels of family-aided assertive community treatment.

OBJECTIVE: The study examined differences in outcomes for patients with schizophrenic disorders who were receiving assertive community treatment based on whether their families were involved in their treatment more intensively in psychoeducational multifamily groups or episodically in crisis family intervention. METHODS: Sixty-eight individuals who met DSM-III-R criteria for schizophrenic disorders and who had at least one other major complicating factor were randomly assigned to the two treatment conditions, and clinical and functional outcomes over a 24-month follow-up period were compared. RESULTS: Both groups had significant reductions in rehospitalization rates and symptom levels and increased participation in treatment. Patients in multifamily group treatment had higher employment rates during the study. Otherwise, few significant differences in the major outcome variables were found. In both treatment conditions family members reported significant improvements in their objective and subjective burden; in friction, dissatisfaction, and overinvolvement with the patient; and in the patient's functioning. CONCLUSIONS: The results suggest that systematic family involvement enhances the rehabilitation and family-related outcomes of assertive community treatment. Patients in multifamily group treatment had better employment outcomes.

Multiple-family groups and psychoeducation in the treatment of schizophrenia.

OBJECTIVE: To compare outcomes in psychoeducational multiple-family group treatment vs psychoeducational single-family treatment. METHOD: A total of 172 acutely psychotic patients, aged 18 to 45 years, with DSM-III-R schizophrenic disorders were randomly assigned to single- or multiple-family psychoeducational treatment at six public hospitals in the state of New York. Psychotic relapse, symptom status, medication compliance, rehospitalization, and employment were assessed independently during 2 years of supervised treatment. RESULTS: The multiple-family groups yielded significantly lower 2-year cumulative relapse rates than did the single-family modality (16% vs 27%) and achieved markedly lower rates in patients whose conditions had not remitted at index hospital discharge (13% vs 33%). The relapse hazard ratio between treatments was 1:3. The relapse rate for both modalities was less than half the expected rate (65% to 80% for 2 years) for patients receiving individual treatment and medication. Rehospitalization rates and psychotic symptoms decreased significantly, and medication compliance was high, to an equal degree in both modalities. CONCLUSION: Psychoeducational multiple-family groups were more effective than single-family treatment in extending remission, especially in patients at higher risk for relapse, with a cost-benefit ratio of up to 1:34.

Psychoeducational multiple family groups: four-year relapse outcome in schizophrenia.

Earlier studies of family psychoeducation and clinical reports on multiple family groups (MFGs) have reported substantial reductions in relapse rates for patients with schizophrenia. These groups offer an expanded social network and thereby may confer a margin of protection against relapse. However, to date, there has not been an empirical trial of this modality. The advent of family psychoeducational and behavioral management strategies provided the basis for an experimental, three-way comparison of psychoeducational MFGs to psychoeducation in a single-family format and to MFGs without psychoeducation, using symptomatic relapse as the outcome criterion. After 4 years, the psychoeducational MFGs were significantly more effective in extending remission than the single-family format, while the MFGs without psychoeducation approximated outcome in the psychoeducational MFGs. The respective relapse rates at 4 years were 50%, 78%, and 57%; MFGs averaged 12.5% and 14% per year. These results point toward an enhanced and independent, long-term therapeutic effect for multiple family groups, when combined with antipsychotic medication and psychoeducation, with especially promising cost-effectiveness.