Methadone patients and alcohol abuse.

A literature review was conducted on the excess use of alcohol by methadone patients. Although the rate of alcohol abuse among methadone patients was found to be high (compared to general population estimates), the rate was comparable to individuals who engaged in risk-taking behaviors and individuals under stress, such as college students and emergency room patients. Comparisons of rates for different samples was difficult because of the varying criteria used to define alcohol abuse and the absence of operational criteria applicable across different populations. Another source of difficulty was that some studies evaluated motivational variables (why the person drank) and found them to be more important predictors than sociodemographic variables (for example, history of drinking and social class). Contrary to the expectation that methadone patients who consumed excessive amounts of alcohol would require higher dosages of methadone, it was found that nonalcohol-abusing methadone patients requested the higher dosage levels. This finding, however, was subject to methodological confounds. The issue of whether the methadone patient who abused alcohol has a negative treatment outcome was a multifaceted question. The definition of treatment outcome for alcohol-abusing methadone patients determined whether the investigator concluded that there was a negative impact versus minimal impact.

Reliability of the Weak Opiate Withdrawal Scale for inter-city opiate users.

The reliability (Kuder-Richardson 20) of the 84-item Weak Opiate Withdrawal Scale was estimated for a sample of 70 inner-city men who used opiates and had passed through the acute withdrawal stage. Analysis suggested modification of the scale to exclude negatively worded as well as cognitively sophisticated items which elicit unreliable and paradoxical responses from this population.

Risk dimensions of HIV-tested substance users.

Methadone outpatients (n = 177) and outpatients enrolled in a nonchemotherapy (n = 65) counseling unit requested HIV testing. A HIV risk-related questionnaire elicited information on needle-sharing, drug injecting, sexual behaviors, and other risk activities. Although age and geographical seroprevalence were not significantly related to a positive HIV test result, a significant relationship was found between the patient's self-report of AIDS deaths among personal acquaintances and serostatus. Dimensions of risk concerns were found to be significantly related to gender in the methadone sample but not in the nonchemotherapy sample. Serostatus in the nonchemotherapy sample was significantly related to drug injecting and the sum of a 12-item risk index constructed to predict HIV infection.

I.v. versus non-i.v. drug use and selected patient variables related to AIDS risk behaviors.

A sample of 206 drug users volunteered for a survey questionnaire of AIDS-related risk behaviors. The Risk Behavior Inventory (RBI) was used to elicit self-report information on risk behaviors including drug use, needle use, and sexual practices. Non-IV cocaine users reported less risk behaviors than patients involved in IV drug use. Nevertheless, non-IV users remained substantially at risk for HIV exposure because of sexual practices and sexual interaction with IV drug users. Multiple regression analysis indicated that method of drug administration (IV vs non-IV) was the major contributor of accountable variance in risk behaviors, while other patient variables, such as age, gender, educational level, employment, and marital status, did not contribute significantly to the explained variance.

Safe sex behavior in drug-addicted males as a function of object relations.

An inventory of sexual behavior was administered in a hospital detoxification program to 127 drug-addicted males, who also completed a modified form of the Defense Mechanisms Inventory (DMI) which yields a measure of object relations. Condom use was shown to be related to an object relations mode that typifies the individual who can structure reality and needs without requiring an integral aspect of "the other" in his approach. Standardization and factor analytic data are also presented for the DMI and the object relations measure for this population. The resulting pattern and the small effect size are discussed within the reality constraints of the addicted patient, as well as within the psychometric parameters inherent in psychoanalytic research.

Condom knowledge, history of use, and attitudes among chemically addicted populations.

The need for behavioral change of risky sexual practices has been of the highest priority since the onset of the AIDS epidemic. The major focus of education for safe sex has been emphasis on condom use. We surveyed 124 individuals applying to treatment for various chemical dependencies and 60 individuals applying for non-chemical-dependency medical treatment on various aspects of condom knowledge, history of use, and attitudes. Respondents reported that AIDS has motivated them to increase their use of condoms, however, only 13.9% always use them. Education is needed in the areas of increasing protection. Along with the use of a condom, the need for a reservoir tip and the risks associated with multiple sex partners should be stressed.

PIP: This report contains the findings of a survey designed to investigate the knowledge of condoms, history of use, and attitudes among chemically attitudes among chemically addicted populations. The study took place in the Division of Alcohol and Drug Dependence of the SUNY Health Science Center at Brooklyn, Department of Psychiatry, Kings Country Addictive Disease Hospitals. Researchers interviewed 124 individuals seeking treatment for chemical dependency, as well as 60 individuals applying for non-chemical dependency treatment to serve as controls. 25% of those interviewed reported intravenous injection as their primary route of drug administration, 25% reported smoking crack of sniffing cocaine, 17.4% cited alcohol abuse. The remaining 32.6% made up the control group. In a few instances, drug users scored better than the controls on condom knowledge, but overall, the survey found no significant differences in the level of knowledge about AIDS and condoms use among the drug, alcohol, and control groups. As expected, the survey found that those individuals who have a history of condom use scored higher on the knowledge quiz than those with less experience. Very few individuals in any of the groups mentioned monogamy as a strategy for risk reduction, or mentioned multiple sex partners as high-risk activity. While sensitivity and embarrassment did not play a significant role in condom use frequency, 26.1% of those interviewed agreed with the statement "If my partner doesn't mention using a condom neither will I." 32% of males and 57.1% of females reported having has a sex partner refuse to use a condom. These findings, the report explains, suggest the need to address sexually risky behavior within the chemically addicted populations.

AIDS-related risk behaviors among substance abusers.

Ninety-two substance abusers were surveyed about AIDS-related risk behaviors. The questionnaire administered elicited information on demographics, sexual practices, substance abuse, and risk behaviors involving the use of needles. Results indicated an appropriate base of prevention knowledge and patients' efforts to modify vulnerability to HIV exposure. Nevertheless, patients continue to engage in behaviors resulting in HIV exposure and transmission.

DMI-measured defenses and HIV-related risk behaviors in i.v. compared to non-i.v. substance abusers.

The Defense Mechanism Inventory (DMI) and The Risk Behavior Inventory (RBI) were administered to substance abusers hospitalized on a drug detoxification service. The groups were categorized on the basis of self-reported IV versus non-IV substance abuse. Significant between-group differences were obtained on the DMI and RBI. The non-IV group responded less often than the IV group with the Turning Against Object (TAO) response option, resulting in higher scores when Turning Against Self (TAS), Reversal (REV), Principalization (PRN) and Projection (PRO) were summed into a single score. Significant within-group differences were obtained for DMI response levels and defenses. Both groups relied less on TAO at the thought level and more on PRN and REV as primary defenses. The IV group reported twice as many risk behaviors as the non-IV group and risked HIV exposure through needle use and sexual transmission modes. Consideration was given to the role of principalization and denial within the addicted individual's defense structure and the relationship of these defenses to HIV-related risk behavior.

A behavioral measure of AIDS information seeking by drug and alcohol inpatients.

A nonreactive, observational research method was used to measure AIDS information-seeking behavior of patients on four drug and alcohol inpatient units at a large public hospital in New York City. Results showed only 23 inquiries from 271 male and female patients over a six-week interval. Possible explanations and implications of these results are discussed.

Patient expectations and participation in a polydrug treatment program: a replicated field process study.

Substance abusers enrolled in a polydrug treatment program were administered Q sorts using items eliciting patients' attitudes toward types of treatment services as well as their counselor preferences and expected duration of treatment enrollment. An attempt was made to relate the patients' treatment expectations to their participation in the program service areas. Two independent patient samples (N = 72, N = 96) were surveyed over a 2-year period. Scales developed through factor analysis of the items sorted by the first sample generally replicated on the second sample. Significant differences were found for expectations and program participation between the two samples, but within-group relationships found in the first sample generally did not replicate on the second sample.

Patient improvement, measured by the MMPI and Pyp, related to paraprofessional and professional counselor assignment.

This study examined the treatment efficacy of professional and paraprofessional counselors with similar caseloads of narcotic addicts stabilizaed on methadone. The patients assigned to a professional counselor showed a statistically significant decrease on the D and Sc scales of the MMPI. The patients assigned to paraprofessional counselors did not demonstrate statistically significant decreases on the scales of the MMPI. On the basis of examined patient variables, the two groups of patients appeared comparable in terms of demographic characteristics prior to admission and there did not appear to be a bias in the assignment of patient to counselor.

Follow-up of a token economy applied to civilly committed narcotic addicts.

Thirty-one civil-commitment, male, heroin addicts participated in an intramural token economy designed to reinforce the rehabilitative process by programming the incentive of length of residential stay. The project evaluated participation in rehabilitative activities during intramural stay, personality change as measured by the MMPI, and follow-up of the participants' community aftercare retention. The token economy had a substantial impact on the participants' institutional adjustment but had little influence on the evaluative dimensions of personality change and rate of aftercare retention.

SECOND ORDER ANALYSIS OF COMREY'S ELEVEN FACTOR SOLUTION.

A second order analysis was conducted on the Comrey inventory. The analysis did not approach an adequate solution until eight factors were isolated. The eight factor solution was rejected on the basis that it com- pressed major factors while exaggerating he importance of minor factors.