Substance use disorders and treatment utilization among MDMA users: Results from The National Epidemiologic Survey on Alcohol and Related Conditions.

The study examined the prevalence and correlates of substance use disorders and treatment utilization among lifetime MDMA users. Secondary analyses were conducted on data from the 2001-2002 NESARC, a nationally representative survey of adults in the United States. Lifetime MDMA use was assessed, and MDMA users (n = 562) were compared to a matched sample of non-MDMA users. Substance use diagnoses were made using the AUDADIS - DSM-IV, and data on treatment utilization were collected. MDMA use was significantly related to lifetime and past year substance use disorders as well as treatment utilization in bivariate analyses. Multivariate analysis, however, showed that MDMA use was not related to lifetime substance use diagnosis or to treatment utilization. MDMA use still had the strongest association with past year substance use disorders.

Diagnosis, self-help, and maintenance care as key constructs in treatment research for "alcohol use disorders" (AUD).

OBJECTIVE: This study examines a sample of alcohol user treatment outcome studies to determine the amount of attention given to three areas of concern and cost-effectiveness in treatment research: patient diagnosis, use of self-help groups (e.g., Alcoholics Anonymous [AA]), and use of maintenance care services (also known as a "aftercare"). METHOD: A preliminary sample of 40 studies was coded for the degree of specific information provided to each of the three areas of interest. RESULTS: Eight studies in the sample did not mention the diagnostic criteria used to determine patient addiction, 18 did not mention use, referral, or recommendation of AA, and 20 did not mention use, referral, or recommendation of maintenance care services. CONCLUSIONS: As cost-effective additions to primary treatment, AA and maintenance care services deserve greater attention in the treatment of "substance abuse disorders." Researchers should also pay greater attention to patient diagnosis as an integral part of patient care. Finally, journal editors should institute minimum requirements for published reports ensuring that sufficient information on patient care is provided.

Psychotherapy research: basic or applied?

Borkovec and Miranda (1996) have argued that the "greatest progress in the development of increasingly useful interventions" (p. 14) will come from redefining comparative trials research on psychotherapy outcome as basic research. They foresee that such a reconceptualization will lead to the increased use of dismantling, parametric, and additive research strategies and that it will result in increasing collaboration with other basic researchers. The assumption that a redefinition will stimulate increased collaboration and specificity of causal mechanisms is questioned as are the assumptions that randomization, group comparison designs, and within therapist designs will lead inherently to more valid assessments of cause-effect relationships. Analyses of a randomized clinical trials study is used to illustrate how clinical research can be guided by theory to tease out causal relationships, within therapy, and within patient factors. Ultimately, a combination of research paradigms, including N = 1, clinical utility, and controlled research, will best provide answers to important questions of change mechanisms and treatment effectiveness. A simple reconceptualization, however, is not necessary to make this happen and belies the complexity and overlap of the problems to be addressed.