Videotaped training in alcohol counseling for obstetric care practitioners: a randomized controlled trial.

OBJECTIVE: To determine the feasibility of videotaped training for obstetric care practitioners in motivational interviewing skills that could be used in brief patient consultations on problem drinking. METHODS: Thirty health care practitioners participated in a clinical trial using a 20-minute videotape to instruct them in motivational interviewing. Participants engaged in a pretest roleplay with an actress playing a drinking pregnant woman. Those randomly assigned to the experimental condition watched the motivational interviewing videotape. Control condition participants watched a 20-minute docudrama of a pregnant problem drinker. Both groups then engaged in a post-test roleplay similar to the pretest. Behavioral ratings of the roleplays and participant evaluations of the motivational interviewing video constituted the outcome measures. RESULTS: Participant evaluations indicated that the training video was clear in explaining and demonstrating the principles and skills of motivational interviewing. Change in behavioral ratings from pretest to post-test showed significant differences in motivational interviewing skills between the experimental and control groups. Obstetric care practitioners who viewed the training video were rated as showing greater empathy, minimizing patient defensiveness, and supporting women's beliefs in their ability to change. CONCLUSION: Obstetric care practitioners can improve their alcohol intervention skills through the use of a 20-minute videotaped instruction in motivational interviewing. Clinicians who improve their skills in motivational interviewing can intervene more effectively with their drinking pregnant patients. Using motivational interviewing with this population holds promise for helping prevent alcohol-related health problems.

AIDS risk behavior in opioid dependent patients treated with community reinforcement approach and relationships with psychiatric disorders.

This study examined the Community Reinforcement Approach's (CRA) effect on AIDS risk behaviors and the relationship between comorbid psychiatric disorders and the risk for AIDS behavior in opioid dependent patients entering methadone maintenance treatment. Additionally, we looked at AIDS risk behaviors as they related to the Addition Severity Index (ASI), Beck Depression Inventory, Symptom Checklist-90-Revised (SCL-90-R), and the Social Adjustment Scale-Self Report (SAS-SR). Subjects (N = 227) were drawn from a large clinical trial that examined the effectiveness of a Community Reinforcement Approach for treatment of opioid dependence. Both CRA and standard treatment demonstrated a significant effect on reduction of AIDS risk behaviors. There was no relationship found regarding comorbid psychiatric disorders with the risk for AIDS behavior. However, there were correlations with other psychiatric, social, and substance abuse variables. Multivariate analyses indicated that increased drug and legal ASI composite scores were the primary predictors of increased AIDS risk behavior.

The community reinforcement approach with homeless alcohol-dependent individuals.

Homeless alcohol-dependent individuals were randomly assigned to receive either a behavioral intervention (i.e., the Community Reinforcement Approach [CRA]) or the standard treatment (STD) at a large day shelter. Ninety-one men and 15 women participated. The majority of participants were White (64%), but both Hispanic (19%) and Native American (13%) individuals were represented as well. Overall, the decline in drinking levels from intake through follow-ups was significant. As predicted, CRA participants significantly outperformed STD group members on drinking measures across the 5 follow-ups, which ranged from 2 months to 1 year after intake. Both conditions showed marked improvement in employment and housing stability.

Community reinforcement approach in the treatment of opiate addicts.

The authors studied the efficacy of the community reinforcement approach (CRA) as compared to standard counseling in opiate-dependent patients on methadone maintenance. One hundred eighty subjects were randomized to three treatment conditions: standard, CRA, and CRA with relapse prevention (CRA/RP). Of these, 151 subjects were followed up 6 months after intake. Since few of the RP sessions had been concluded at the 6-month follow-up, the two CRA groups were combined for analyses. Weekly urinalysis drug screens and Addiction Severity Index (ASI) scores at intake and 6 months were compared. The combined CRA groups did significantly better than the standard group in the following areas: consecutive opiate-negative urinalysis (3 weeks), and the 6-month ASI drug composite score. These results support the benefit of adding CRA strategies to the treatment of patients who are opiate dependent and on methadone maintenance. Because of insufficient treatment exposure to RP at the 6-month follow-up, the additive effect of RP could not be adequately evaluated; further follow-up will be required.

Behavioral Self-Control Program for Windows: results of a controlled clinical trial.

Forty nonalcoholic heavy drinkers were randomly assigned to receive a computer-based version of behavioral self-control training either immediately after pretreatment assessment or after a 10-week waiting period. Results at each of 3 follow-ups strongly support the study hypotheses. Participants in the immediate treatment group significantly reduced their drinking relative to their pretreatment levels and relative to those in the delayed treatment condition at the initial follow-up, 10 weeks after the pretreatment assessment. The delayed group did not change their drinking behaviors during this period of time. However, they significantly reduced their drinking by the second follow-up conducted after they received training. At the 12-month follow-up, participants maintained the gains they had achieved during treatment. There were no interactions involving participant ethnicity or gender. Although use of other drugs was not specifically addressed, such use did not increase, and there was some evidence of a decline.

CT scan cerebral hemispheric asymmetries: predictors of recovery from aphasia.

Individual variations in anatomic cerebral asymmetries have been linked with specific neurodevelopmental processes, with patterns of cognitive ability, and with recovery from focal brain damage. The present study investigated relationships between cerebral asymmetries and recovery from aphasia. Aphasic patients (N = 25) were assessed for language recovery for 1 year poststroke, and linear measurements of cerebral asymmetries were performed on CT scans. Increasing left occipital width asymmetry was associated with faster rate of language recovery and with higher final language scores during the first year poststroke. There was, moreover, a tendency for increasing left occipital width asymmetry to be associated with less initial impairment. It is hypothesized that those aspects of neural organization conferring better premorbid language skills are the same factors conferring greater recovery of language skills and that occipital width asymmetry serves as a marker for such individual differences in neural organization.

Long-term follow-up of behavioral self-control training.

Four samples of problem drinkers treated by behavioral self-control training were evaluated at 3.5, 5, 7 and 8 years following treatment, respectively. Of 140 cases, 99 (71%) were accounted for: 23 abstinent, 14 with controlled and asymptomatic drinking, 22 improved but still impaired, 35 unremitted and 5 deceased. Abstinent versus controlled-drinking outcomes were most strongly differentiated by pretreatment severity of alcohol problems and dependence and by the patients' pretreatment self-assessment and goals. Percentages of abstainers and of relapsed cases increased at long-term follow-ups. A reasonably constant percentage of known outcomes (14%) were clearly controlled and asymptomatic drinkers in each of the follow-up samples. Most of the long-term controlled drinkers had established this pattern within the first year following treatment. However, periods of controlled drinking during the first year did not reliably predict maintenance of this pattern. Successful asymptomatic drinkers were discriminable from other outcomes based on pretreatment characteristics.

On Using Analysis Of Covariance In Repeated Measures Designs.

The use of analysis of covariance in conjunction with the multivariate approach to analyzing repeated measures designs is considered for designs involving between- and within-subject factors, one dependent variable, and one observation per subject on the covariate. Considerations fundamental to a knowledgeable application of ANCOVA in this situation are detailed including issues related to (1) the validity of the test of the main effect of the within-subject factor, (2) the desirability of an interaction between the within-subject factor and the premeasure score, and (3) the reliability of change scores. Tables providing upper bounds on the correlations of the covariate with change scores are provided. Numerical examples illustrating various analyses of repeated measures designs are also presented.