Multidimensional assessment of perceived treatment-entry pressures among substance abusers.

Motivational assessment instruments typically measure clients' attributions about their readiness to change problem behaviors. They do not indicate why a client may be motivated to change, or provide guidance on how to retain an unmotivated client in treatment. The authors interviewed 415 substance abuse clients about their reasons for entering treatment and scored their responses along the dimensions of (a) negative versus positive treatment-entry pressures, (b) internal versus external sources of those pressures, and (c) the life domain from which the pressures emanated. Exploratory cluster analysis yielded 5 types of clients characterized by different profiles of perceived treatment-entry pressures. Cluster membership was predictive of treatment outcomes, and the clusters differed by demographic variables. These data support the discriminative and predictive utility of performing a multidimensional assessment of pressures to enter treatment.

Community reinforcement training for family and significant others of drug abusers: a unilateral intervention to increase treatment entry of drug users.

We randomly assigned 32 concerned family members and significant others (FSOs) of drug users (DUs) to a community reinforcement training intervention or a popular 12-step self-help group. We measured problems arising from the DU's behavior, social functioning of the DU and FSO, and mood of the FSO at baseline and 10 weeks later. We also monitored the FSOs' treatment attendance and treatment entry of the DUs. The treatment groups showed equal reductions from baseline to follow-up in problems and improvements in social functioning and mood of the FSO. However the community reinforcement intervention was significantly better at retaining FSOs in treatment and inducing treatment entry of the DUs.

Schedule of voucher delivery influences initiation of cocaine abstinence.

This study examined whether voucher delivery arrangements affect treatment outcome. First, 90 cocaine-dependent adults were randomly assigned to behavioral counseling or counseling plus vouchers for cocaine-free urine samples. The value of each voucher was low at the beginning but increased as the patient progressed (Voucher Schedule 1). Voucher Schedule 1 produced no improvements relative to counseling only. Next, 23 patients received vouchers on either Voucher Schedule 1 or Voucher Schedule 2. Voucher Schedule 2 began with high voucher values, but requirements for earning vouchers increased as the patient progressed. Average durations of cocaine abstinence were 6.9 weeks on Voucher Schedule 2 versus 2.0 weeks on Voucher Schedule 1 (p = .02). This confirms that vouchers can assist in initiating abstinence and that voucher delivery arrangements are critical.

Congruence of the MCMI-II and MCMI-III in cocaine dependence.

This study compared the MCMI-II and MCMI-III among 40 urban, poor, cocaine abusers in outpatient treatment. The mean group profiles had strikingly similar relative elevations on the Antisocial, Narcissistic, Aggressive-Sadistic, Alcohol Dependence, and Drug Dependence scales. However, the MCMI-III group profile was significantly lower in magnitude compared with the MCMI-II. Interval and rank-order correlations were moderate to low for most scales, and 90% of participants produced discrepant 2-point codetypes between the 2 tests. These results suggest that clinicians working in substance abuse settings should perhaps adjust MCMI-III profile elevations upward on most scales (particularly on the personality disorder scales) when comparing results to extant normative data and should use caution when referencing MCMI/MCMI-II interpretive manuals for descriptive correlates of MCMI-III scales and codetypes.

Impact of comorbid personality disorders and personality disorder symptoms on outcomes of behavioral treatment for cocaine dependence.

Studies have revealed a significant adverse impact of comorbid personality disorders on treatment tenure and outcome in a variety of psychiatric and substance abuse populations. We investigated whether this negative relationship also exists among 137 urban, poor, cocaine abusers in behaviorally oriented treatment. Axis II diagnoses were generated categorically using the SCID-II as well as dimensionally using numbers of SCID-II symptoms within diagnostic categories. Contrary to expectations, there were no significant differences between subjects with and without various categorical personality disorders on any outcome measures. Categorical Axis II diagnoses were also minimally correlated with drug use severity, depression, and anxiety at intake, indicating that these were not potential coveriates of outcome. However, dimensional analyses of personality symptoms generated from the SCID-II accounted for substantial proportions of variance in treatment outcomes. Implications of these data for Axis II assessment and drug treatment planning are discussed.

Assessment of coercive and noncoercive pressures to enter drug abuse treatment.

This paper reports preliminary data derived from a standardized interview scoring procedure for detecting and characterizing coercive and noncoercive pressures to enter substance abuse treatment. Coercive and noncoercive pressures stemming from multiple psychosocial domains are operationalized through recourse to established behavioral principles. Inter-rater reliability for the scoring procedure was exceptional over numerous rater trials. Substantive analyses indicate that, among clients in outpatient cocaine treatment, 'coercion' is operative in multiple psychosocial domains, and that subjects perceive legal pressures as exerting substantially less influence over their decisions to enter treatment than informal psychosocial pressures. Implications for drug treatment planning, legal and ethical issues, and directions for future research are proposed.

The accelerated intake: a method for increasing initial attendance to outpatient cocaine treatment.

We examined whether offering an accelerated (same-day) versus a standard (1- to 7-day delay) intake appointment increased initial attendance at an outpatient cocaine treatment program. Significantly more of the subjects who were offered an accelerated intake (59%) attended than those who were given a standard intake (33%), chi 2 (2, N = 78) = 4.198, p < .05. The accelerated intake procedure appears to be useful for enhancing enrollment in outpatient addiction treatment.

Pretreatment dropout as a function of treatment delay and client variables.

Utilizing a retrospective analysis we examined factors correlated with preintake dropout in patients phoning to make intake appointments for cocaine treatment. Inquiries of 235 individuals calling our outpatient cocaine treatment program over a 7-month period were analyzed for relationships between patient age and gender; residence in the city where the program is located; marital status; referral source; reported problems with alcohol, marijuana, and heroin; reported last use of cocaine or other illicit stimulants; assigned counselor gender; person who made the appointment; days to the intake appointment; and attending the scheduled intake session. Only days to appointment was significantly (Wald = 12.4587, df = 1, p < .05 and chi 2 = 17.7, df = 8, p < .05) correlated with attending the scheduled intake session. Appointments scheduled the same day differed significantly (chi 2 = 4.3, n = 235, df = 1, p < .05) from appointments scheduled later. This suggests that client and situational variables are not significantly related to initial attendance and enhances the significance of systemic variables that are under a clinic's control, such as appointment delay. The results indicate that the longer the delay between the initial phone contact and the scheduled appointment, the less likely a client is to attend an appointment. Further, they suggest that the greatest decrease in initial attendance occurs in the first 24 hours following the phone inquiry. Taking a "microscopic" look at the appointment delay variable is valuable in understanding and addressing preintake dropout.